ObjectiveTo investigate whether anti-programmed death-1 （PD-1） monoclonal antibody can enhance the efficacy and safety of argon-helium cryoablation combined with targeted therapy in patients with unresectable hepatocellular carcinoma （uHCC） aged 60 years or older. MethodsA retrospective analysis was performed for the clinical data of 124 patients with advanced uHCC aged 60 years or older who were treated at The Fifth Medical Center of Chinese PLA General Hospital from January 2013 to September 2024. After propensity score matching， 57 patients received cryoablation combined with targeted therapy （double combination group）， while 57 received cryoablation combined with targeted therapy and anti-PD-1 monoclonal antibody （triple combination group）. The indicators for efficacy assessment included objective response rate （ORR）， disease control rate （DCR）， progression-free survival （PFS）， overall survival （OS）， and the incidence rate of adverse events. The Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to plot survival curves， and the Log-rank test was used for comparison between groups. A Cox proportional-hazards regression model analysis was used to investigate the influencing factors for survival prognosis. ResultsThe triple combination group had a significantly higher ORR than the double combination group （59.6% vs 29.8%， χ²=9.083， P=0.003）， while there was no significant difference in DCR between the two groups （87.7% vs 77.2%， χ²=1.516， P=0.218）， and compared with the double combination group， the triple combination group had significantly longer median PFS （9.1 months vs 4.8 months， χ²=7.813， P=0.005） and median OS （26.1 months vs 13.6 months， χ²=14.199， P<0.001）. The multivariate Cox proportional-hazards regression model analysis showed that triple combination treatment was an independent influencing factor for PFS （hazard ratio ［HR］=0.52， 95% confidence interval ［CI］： 0.35 — 0.78， P=0.001） and OS （HR=0.32， 95%CI： 0.20 — 0.51， P<0.001）. There was no significant difference in the incidence rate of adverse events between the two groups （P>0.05）. ConclusionTriple combination treatment with argon-helium cryoablation， targeted therapy， and anti-PD-1 monoclonal antibody can significantly improve survival benefits in uHCC patients aged 60 years or older， with a controllable safety profile.

ObjectiveTo investigate the syndrome evolution patterns， characteristics of the used herbal medicinals， and efficacy variations across different stages of rheumatoid arthritis （RA） progression. MethodsBased on the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine （CERTAIN）， 2,506 RA patients were retrospectively enrolled and categorized into ＜6 months group （166 cases）， 6 months to ＜5 years group （1063 cases）， 5 to ＜20 years group （1067 cases）， and ≥20 years group （210 cases）. Syndromes were differentiated before and after traditional Chinese medicine （TCM） treatment， including damp-heat obstruction， wind-damp obstruction， cold-damp obstruction， blood stasis obstructed in the collaterals， phlegm-stasis obstruction， liver-kidney insufficiency， qi and blood deficiency， and qi-yin deficiency. The syndrome evolution rate was calculated for high-frequency syndromes before and after treatment. Analysis was conducted on top 20 frequently used Chinese herbs at the first diagnosis. Clinical efficacy of the 28-joint disease activity score based on erythrocyte sedimentation rate （DAS28-ESR） and 28-joint disease activity score based on C-reactive protein （DAS28-CRP） before and after treatment were assessed. A multivariate logistic regression analysis was performed to identify factors affecting the efficacy of TCM treatment. ResultsPatients with course of disease shorter than 6 months predominantly presented with cold-dampness obstruction syndrome （49/166， 29.5%）， wind-dampness obstruction syndrome （46/166， 27.7%）， and dampness-heat obstruction syndrome （43/166， 25.9%）. For patients with course of disease logner than 6 months and shorter than 5 years and those within 5 to 20 years， the dominant syndrome was dampness-heat obstruction syndrome （324/1063， 30.5% and 318/1067， 29.8%， respectively）. In patients with disease duration ≥20 years， liver-kidney insufficiency syndrome and dampness-heat obstruction syndrome both predominated， each accounting for 25.24% （53/210）. The syndromes with more than 100 cases before treatment and a syndrome evolution rate greater than 10% after treatment were dampness-heat obstruction （201/738， 27.2%）， liver-kidney insufficiency （119/367， 32.4%）， and phlegm-stasis obstruction syndromes （73/172， 42.4%）. These were classified as high-frequency syndromes. After treatment， damp-heat obstruction syndrome and liver-kidney insufficiency syndrome primarily evolved into wind-damp obstruction syndrome， while phlegm-stasis obstruction syndrome evolved into damp-heat obstruction and cold-damp obstruction syndrome. The top two commonly used Chinese herbs across all groups were Gancao （Radix et Rhizoma Glycyrrhizae） and Baishao （Radix Paeoniae Alba）. In the ＜6 months group and the 6 months to ＜5 years group， high-frequency herbs also included Fangfeng （Radix Saposhnikoviae）， Duhuo （Radix Angelicae Pubescentis）， Chuanxiong （Rhizoma Chuanxiong）， and Qianghuo （Radix et Rhizoma Notopterygii）. In the 5 to ＜20 years group and the ≥20 years group， the usage of Huangqi （Radix Astragali）， Fuling （Poria）， Niuxi （Radix Achyranthis Bidentatae）， and Danggui （Radix Angelicae Sinensis） increased， while the proportion of Fangfeng and Duhuo decreased. After treatment， the DAS28-ESR and DAS28-CRP scores in all groups significantly decreased （P＜0.05）. There were statistically significant differences in clinical efficacy based on DAS28-ESR and DAS28-CRP across all groups （P＜0.01）. Multivariate logistic regression revealed significantly reduced treatment efficacy in the 6 months-5 years group （OR=0.4）， 5~20 years group （OR=0.5）， and ≥20 years group （OR=0.4） compared to the ＜6 months group. ConclusionRA syndromes follow a progression pattern from excess to deficiency， with corresponding transition in herbal usage from pathogen-eliminating to healthy qi-reinforcing approaches. TCM intervention can significantly reduce disease activity of RA， with superior efficacy in patients with disease duration shorter than 6 months.

Objective To investigate the MRI regression pattern and its relationship with prognosis in triple-negative breast cancer after neoadjuvant chemotherapy.Methods A total of 121 patients with triple-negative breast cancer were prospectively selected.All patients were given neoadjuvant chemotherapy and radical mastectomy.MRI was performed before and after neoadjuvant chemotherapy to observe their MRI regression pattern.Patients were followed up for 3 years to record their prognosis.The factors affecting prognosis of patients with triple-negative breast cancer after neoadjuvant chemotherapy were analyzed,and the MRI regression pattern and its relationship with prognosis were analyzed.Results MRI regression pattern after neoadjuvant chemotherapy was centripetal regression in 68 patients and non-centripetal regression in 53 patients(20 patients with fragmented regression and 33 patients with mixed regression).The MRI centripetal regression rate of triple-negative breast cancer patients with medium-high differentiation,stage Ⅱ,no lymph node metastasis and pathological complete response(pCR)was higher than that of patients with low differentiation,stage Ⅲ,with lymph node metastasis and no pCR,respectively(P＜0.05).Cox regression analysis showed that tumor stage,differentiation degree,pCR,MRI regression pattern were the factors affecting prognosis of triple-negative breast cancer patients after neoadjuvant chemotherapy(P＜0.05).Receiver operating characteristic(ROC)curve analysis results showed that the sensitivity of MRI regression pattern in predicting prognosis after neoadjuvant chemotherapy for triple-negative breast cancer patients was 84.62％,the specificity was 88.75％,and the area under the curve(AUC)was 0.870[95％confidence interval(CI)0.800-0.940].The disease-free survival curve of patients with MRI centripetal regression was better than that of patients with MRI non-centripetal regression(P＜0.05).Conclusion MRI regression pattern after neoadjuvant chemotherapy for triple-negative breast cancer is closely related to the pathological characteristics and prognosis of patients.MRI regression pattern has a good prognostic effect,and patients with MRI non-centripetal regression have a higher risk of poor prognosis.

Objective To investigate the MRI regression pattern and its relationship with prognosis in triple-negative breast cancer after neoadjuvant chemotherapy.Methods A total of 121 patients with triple-negative breast cancer were prospectively selected.All patients were given neoadjuvant chemotherapy and radical mastectomy.MRI was performed before and after neoadjuvant chemotherapy to observe their MRI regression pattern.Patients were followed up for 3 years to record their prognosis.The factors affecting prognosis of patients with triple-negative breast cancer after neoadjuvant chemotherapy were analyzed,and the MRI regression pattern and its relationship with prognosis were analyzed.Results MRI regression pattern after neoadjuvant chemotherapy was centripetal regression in 68 patients and non-centripetal regression in 53 patients(20 patients with fragmented regression and 33 patients with mixed regression).The MRI centripetal regression rate of triple-negative breast cancer patients with medium-high differentiation,stage Ⅱ,no lymph node metastasis and pathological complete response(pCR)was higher than that of patients with low differentiation,stage Ⅲ,with lymph node metastasis and no pCR,respectively(P＜0.05).Cox regression analysis showed that tumor stage,differentiation degree,pCR,MRI regression pattern were the factors affecting prognosis of triple-negative breast cancer patients after neoadjuvant chemotherapy(P＜0.05).Receiver operating characteristic(ROC)curve analysis results showed that the sensitivity of MRI regression pattern in predicting prognosis after neoadjuvant chemotherapy for triple-negative breast cancer patients was 84.62％,the specificity was 88.75％,and the area under the curve(AUC)was 0.870[95％confidence interval(CI)0.800-0.940].The disease-free survival curve of patients with MRI centripetal regression was better than that of patients with MRI non-centripetal regression(P＜0.05).Conclusion MRI regression pattern after neoadjuvant chemotherapy for triple-negative breast cancer is closely related to the pathological characteristics and prognosis of patients.MRI regression pattern has a good prognostic effect,and patients with MRI non-centripetal regression have a higher risk of poor prognosis.

Based on the theory of "one qi circulation" founded by HUANG Yuanyu， the core disease mechanism of colorectal cancer is the innate spleen deficiency and stomach qi failing to bear downward， which leads to the turbidity assemble in large intestine， forming the carcinoma toxin， and ultimately transforms into colorectal cancer. The treatment should base on recovering the circulation of qi， Huangya Decoction （黄芽汤） as the basic formula， the circulation of qi ascending and descending as the base， adjusting ascending and descending together with Xiaqi Decoction （下气汤）， and differentiating the syndrome on yin-yang excess-deficiency； for spleen-kidney yang deficiency syndrome， treated with Tianhun Decoction （天魂汤） to supplement liver， kidney and assist yang； for liver-kidney yin deficiency syndrome， treated wtih Dipo Decoction （地魄汤） to supplement lung， kidney， and assist yang. They jointly prompt one qi circulation to provide the thoughts for the treatment of colorectal cancer by traditional Chinese medicine.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Postzygotic mutations are acquired in normal tissues throughout an individual's lifetime and hold clues for identifying mutagenic factors.Here,we investigated postzygotic mutation spectra of healthy individuals using optimized ultra-deep exome sequencing of the time-series samples from the same volunteer as well as the samples from different individuals.In blood,sperm,and muscle cells,we resolved three common types of mutational signatures.Signatures A and B represent clock-like mutational processes,and the polymorphisms of epigenetic regulation genes influence the pro-portion of signature B in mutation profiles.Notably,signature C,characterized by C＞T transitions at GpCpN sites,tends to be a feature of diverse normal tissues.Mutations of this type are likely to occur early during embryonic development,supported by their relatively high allelic frequencies,presence in multiple tissues,and decrease in occurrence with age.Almost none of the public datasets for tumors feature this signature,except for 19.6％of samples of clear cell renal cell carcinoma with increased activation of the hypoxia-inducible factor 1(HIF-1)signaling pathway.Moreover,the accumulation of signature C in the mutation profile was accelerated in a human embryonic stem cell line with drug-induced activation of HIF-1α.Thus,embryonic hypoxia may explain this novel signature across multiple normal tissues.Our study suggests that hypoxic condition in an early stage of embryonic development is a crucial factor inducing C＞T transitions at GpCpN sites;and indi-viduals'genetic background may also influence their postzygotic mutation profiles.

Objective?To observe the complications of nasobiliary drainage patients after endoscopic retrograde cholangiopancreatography (ERCP) and to put forward clinical comprehensive nursing strategies. Methods?From December 2016 to December 2017, 78 patients with endoscopic nasobiliary drainage of Department of Gastroenterology in the 306th Hospital of PLA were selected. The comprehensive nursing was carried out including general nursing, nasobiliary nursing, mouth care, mental nursing, diet nursing, observation of amylase in serum and urine, nursing for nasobiliary drainage related complications. The incidence of patients' complication related to nasobiliary drainage was recorded and analyzed. Results?Catheters of all patients were draw out smoothly. There were 27 patients with nasobiliary drainage related complications along with the incidence of 34.61%. Conclusions?The clinical nursing for nasobiliary drainage related complications is indispensible. The nursing care can reduce the incidence of nasobiliary drainage related complications, contributes to improving patients' experience and reducing the risk of catheter implanting again.

Objective To analyze the HIV-infection related behaviors among unmarried youths in rural areas of Liangshan prefecture from 2011 to 2013 and factors that influencing the HIV transmission in the population under research.Methods According to the HIV sentinel surveillance methods for data collection,EpiData 3.1 and SPSS 19.0 were used to handle data and both Chi-square test and logistic regression were used to explore the related factors.Results A total number of 5 871 qualified youths were involved in this study from 2011 to 2013 with the prevalence rate on HIV infection among those unmarried youths from the rural areas as 3.45％ (201/5 833).27.56％ (1 607/ 5 833) of them had been working outside their hometown area.31.72％ (1 850/5 833) of the unmarried youths had sexual experiences,with 41.46％ (767/1 850) of them had casual sex but the rate of consistent condom use was only 3.46％ (64/1 850).5.04％ (294/5 833) of the unmarried youths admitted of ever having used drugs,with 34.35％ (101/294) of them having the experiences of injecting,with 84.16％ (85/101) of them sharing needles.Rates on factors as:working outside the resident areas,ever having had casual sexual behaviors,drug use and injecting drug use were seen higher among HIV infections,with differences statistically significant (X2=88.72,104.43,4.20,154.39,55.94,P＜0.05).Results from the logistic regression showed that factors as:being male,Yi ethnicity,illiteracy,experience of working outside the resident area,never or casual condom use and needle-sharing drug use etc.would significantly increase the risk of HIV infection.Conclusions HIV infection among unmarried youths from rural areas in Liangshan prefecture called for attention because of the high rates of risk behaviors.Factors as:having had sexual experiences with low condom use,popular injecting drug use with needle sharing,being male,under Yi ethnicity,with lower education level and ever working outside the resident area etc.were under risks that related to HIV infection for unmarried youths in this area.

Objective To investigate the epidemiologic and behavioral characteristics of HIV among community population in Liangshan prefecture.Methods We collected social demographic,behavioral and serological information by means of the monitoring questionnaire and serological tests.Data was analyzed by using the chi-square test and logistic regression.Results From April to June of 2010 to 2015,14 092 cases of community population were selected as the study objects,with 267 cases diagnosed as HIV positive patients.The HIV positive rates were 3.24％,3.07％,1.17％,1.38％,1.42％ and 1.25％,respectively.We observed that when community population having the following characteristics as:living in Butuo country (OR=3.83),being males (OR=1.77),being Yi nationality (OR=4.40) being widowed (OR=28.57),with history of drug abuse (OR=3.71) or injecting drug use (PWID) (OR=4.92),or history of needle sharing among PWID (OR=8.53),were under higher risks for HIV infection.With histories as:having had secondary or above levels of schooling (OR=0.59),having protected sex with regular parmers (OR =0.21) and with non-regular partners (OR =0.46),they seemed to be somehow protected for getting HIV infection.Conclusion The positive HIV rates of HIV among community population in Dechang,Ningnan and Butuo varied from 0.10％ to 8.77％while the HIV transmission among general population remained challenging.