[摘 要] 目的：探究外周血1型辅助性T细胞（Th1）/Th2/Th17细胞相关细胞因子IL-2、IL-4、IL-6、IL-10、IFN-γ、TNF-α、IL-17A对Ⅲ~Ⅳ期肺鳞状细胞癌（LSCC）患者一线免疫治疗联合化疗疗效和预后的预测价值及其动态变化的意义。方法：回顾性分析2020年1月至2023年12月在内蒙古医科大学附属医院接受一线免疫治疗联合化疗的58例Ⅲ~Ⅳ期LSCC患者的临床资料，采集基线及治疗2、4、6周期后和疾病进展时的外周血，用流式细胞术检测Th1/Th2/Th17细胞分泌的细胞因子水平，用受试者工作特性曲线（ROC）确定各细胞因子基线的最佳截断值，据此将患者分为高、低表达组；根据RECIST 1.1标准，将患者分为客观缓解（ORR）[完全缓解（CR） + 部分缓解（PR）]组、非ORR[（疾病稳定（SD） + 疾病进展（PD）]组、疾病控制（DCR）（CR + PR + SD）组和非DCR（即PD）组；根据PD-L1表达评分将患者分为PD-L1 ≥ 1%组和PD-L1 < 1%或未知组。比较组间疗效的差异；分析临床病理特征与疗效的相关性；用广义估计方程（GEE）评估细胞因子动态变化与疗效的关系；用Kaplan-Meier法绘制生存曲线，Log-Rank检验比较组间差异，COX比例风险回归模型进行单因素及多因素预后分析。结果：IL-2和IFN-γ高表达组患者的客观缓解率（ORR）显著高于低表达组患者（P < 0.001）。IL-2、IFN-γ高表达组和IL-10、TNF-α低表达组患者的疾病控制率（DCR）均显著高于对应低/高表达组（P < 0.001）。PD-L1 ≥ 1%组DCR显著高于PD-L1 < 1%或未知组（P < 0.001）。动态分析显示，在4周期及6周期时，有效组患者血清中IL-6表达水平显著低于无效组（P < 0.05），控制组IL-6表达水平显著低于未控制组（P < 0.001）；治疗前及6周期时有效组IFN-γ表达水平显著高于无效组（P < 0.05），治疗前控制组IFN-γ表达水平显著高于未控制组（P < 0.05）。生存分析显示，IL-2低表达组、IL-10高表达组、TNF-α高表达组和IFN-γ低表达组患者的中位PFS显著缩短（均P < 0.05）。COX多因素分析证实，治疗前IL-2 < 2.45 pg/mL和IL-10 ≥ 3.52 pg/mL 是PFS的独立危险因素。结论：外周血Th1/Th2/Th17细胞相关细胞因子的基线水平及动态变化对Ⅲ~Ⅳ期LSCC患者一线免疫治疗联合化疗的疗效和预后具有预测价值。

Objective To evaluate the therapeutic efficacy for surgical treatments among patients with hepatic cystic echinococcosis in Gansu Province from 2006 to 2023, so as to provide insights into optimization of the diagnosis and treatment strategies against hepatic cystic echinococcosis. Methods The demographic and clinical data of all echinococcosis cases included in central government fiscal transfer payment program for echinococcosis control and undergoing surgical treatments in Gansu Province from 2006 to 2023 were captured. Hepatic cystic echinococcosis patients with complete medical records and follow-up data were included in the study, and patients’ characteristics, including hospital where patients received diagnosis and treatment, methods of case identification, year of surgery, classification of lesions, number of lesions, size of lesions, course of disease, surgical methods, and post-surgical follow-up data. The cure and recurrence of hepatic cystic echinococcosis were evaluated according to the Guidelines for Management of Echinococcosis Patients in the Central Government Fiscal Transfer Payment Program, and the cure and recurrent rates were calculated. Results Data were collected from 1 686 surgical patients with hepatic cystic echinococcosis. According to the inclusion and exclusion criteria, 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments were included during the period from 2006 to 2022, including 1 166 cured patients (95.42%) and 88 patients with postsurgical recurrence (7.20%), and the cure rate of surgical treatments appeared a tendency towards a rise among patients with hepatic cystic echinococcosis from 2008 to 2022 (χ²_trend = 19.39, P < 0.05). The cure rates of hepatic cystic echinococcosis were 100% (177/177), 94.81% (128/135) and 94.62% (861/910) among patients detected through regular physical examinations, screened by the central government fiscal transfer payment program for echinococcosis control, and those who passively sought healthcare services, respectively (χ² = 9.95, P < 0.05). The cure rates of hepatic cystic echinococcosis were 95.96% (1 046/1 090) among patients with a disease course of 2 years and less and 90.90% (120/132) among patients with a disease course of over 2 years (χ² = 6.87, P < 0.05), and there were significant differences in the cure rates among patients with hepatic cystic echinococcosis in terms of number of lesions (χ² = 24.44, P < 0.05) and surgical methods (P < 0.05). The cure rate of hepatic cystic echinococcosis patients was significantly higher following initiation of the central government fiscal transfer payment program for echinococcosis control (96.06%, 1 096/1 141) than before the program (86.42%, 70/81) (χ² = 16.06, P < 0.05), and the cure rate of hepatic cystic echinococcosis patients was significantly higher in designated hospitals (96.48%, 741/768) than in non-designated hospitals (93.37%, 366/392) (χ² = 5.78, P < 0.05). The median follow-up period was 4 (interquartile range, 7) years among 1 222 hepatic cystic echinococcosis patients undergoing surgical treatments. The recurrent rate of hepatic cystic echinococcosis appeared a tendency towards a decline from 2008 to 2022 (χ²_trend = 36.86, P < 0.05), with a reduction from 23.08% (9/39) in 2008 to 1.85% (1/54) in 2021, and the post-surgical recurrence rate of hepatic cystic echinococcosis was lower following initiation of the central government fiscal transfer payment program for echinococcosis control (5.87%, 67 / 1 141) than before the program (25.93%, 21/81) (χ² = 45.51, P < 0.05). In addition, the post-surgical recurrence rate of hepatic cystic echinococcosis was higher in non-designated hospitals (10.46%, 41/392) than in designated hospitals (5.60%, 43/768) (χ² = 9.12, P < 0.05), and there was a significant difference in the post-surgical recurrence rate among patients with hepatic cystic echinococcosis in terms of surgical methods (P < 0.05), with the highest recurrence rate (11.54%) seen among patients undergoing percutaneous fine-needle aspiration of cyst fluids-based surgical procedures (P < 0.05). Conclusion Since the initiation of the central government fiscal transfer payment program for echinococcosis control in Gansu Province in 2006, an increase in the surgical cure rate and a reduction in the recurrence of hepatic cystic echinococcosis had been found among patients with hepatic cystic echinococcosis, indicating a high overall therapeutic efficacy.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Objective To investigate the influencing factors of adverse pregnancy outcomes in patients with recurrent spontaneous a-bortion(RSA),construct and validate the Nomogram risk prediction model.Methods A total of 219 patients with RSA admitted to the Second Affiliated Hospital of Kunming Medical University from March 2021 to March 2024 were selected and divided into the poor preg-nancy outcome group(n=129)and the good pregnancy outcome group(n=90)according to the pregnancy outcome.The case data was collected.Results There were statistically significant differences in the leukocyte esterase(LE)positive/negative,hydrogen peroxide(H2O2)positive/negative,bacterial vaginosis(BV),and gestational week of delivery between two groups(P＜0.05).The results of multivariate Logistic regression analysis showed that LE positivity(OR=10.677),H2O2 negativity(OR=3.796),and BV infection(OR=4.827)were the risk factors for adverse pregnancy outcomes in RSA patients,whereas an increase in the gestational week of deliv-ery(OR=0.294)was a protective factor.The area under the curve(AUC)of the Nomogram prediction model constructed based on this was 0.913.The validation results showed that the model had high discrimination,goodness of fit,calibration and net benefit for clinical decision-making.Conclusion Vaginal microecological imbalance and vaginal enzymatic alterations are correlate with adverse pregnancy outcomes in patients with RSA.The Nomogram prediction model constructed on the basis of LE,H2O2,BV and gestational week of deliv-ery can conveniently and efficiently assess the probability of adverse pregnancy outcomes in patients with RSA,and provide a basis for the early identification of high-risk patients and the prevention of the occurrence and development of RSA.

Objective To investigate immune characteristics of non-responsive macrolide-resistant Mycoplasma pneumoniae pneumonia(MPP)and macrolide-susceptible Mycoplasma pneumoniae pneumonia(MSMPP),and the clinical significance of serum Mycoplasma pneumonia DNA load and NK cell count in the course of disease were evaluated.Methods A total of 120 MPP patients hospitalized at Hangzhou Children's Hospital from August 2022 to August 2023 were selected as subjects,they were divided into MSMPP group(n=36)and macrolide-unresponsive MPP(MUMPP)group(n=84)based on whether they were effective within 72h of using macrolide antibiotics.Compare various indicators levels in the first 6 hours after admission between two groups.Multivariate analysis of variance was used for independent risk factors and receiver operating characteristic(ROC)curve analysis was used for diagnostic performance.Results CD4+T,NK,and lgMP-DNA were independent risk factors for predicting whether MPP patients were MUMPP.The area under ROC curve for CD4+T,NK,lgMP-DNA,NK+CD4+T,lgMP-DNA+CD4+T,and lgMP-DNA+NK were 0.684,0.753,0.728,0.803,0.779,and 0.813,respectively.Conclusion Decreased peripheral blood NK cells and high MP-DNA load are important clinical features of drug-resistant Mycoplasma pneumonia,and combined detection can provide important clinical value for subsequent diagnosis and treatment.

Objective:To evaluate the effect of perineal massage during pregnancy, when combined with Kegel exercises, on preventing perineal injury, and to provide a basis for offering safer and more effective delivery intervention measures for expectant mothers.Methods:Randomized controlled trials on perineal massage combined with Kegel exercises for preventing perineal injury were retrieved from databases such as CNKI, Wanfang database, VIP database, CBM database, PubMed, Embase, Web of Science, and Cochrane Library, from their inception to December 28, 2024. Meta-analysis was conducted using RevMan 5.3 software.Results:A total of 15 articles were included, involving 2 393 research subjects. The results of the Meta-analysis showed that there were statistically significant differences in the first stage of labor ( MD = - 1.63, 95% CI - 1.93 - - 1.30, P<0.001), the second stage of labor ( MD = - 32.58, 95% CI - 42.26 - - 22.90, P<0.01), and the third stage of labor time ( MD = - 3.41, 95% CI - 9.91 - - 2.91, P<0.001); the degree of perineal laceration Ⅱ ( OR = 0.40, 95% CI 0.28 - 0.58, P<0.001), Ⅲ( OR = 0.38, 95% CI 0.24 - 0.60, P<0.001), and Ⅳ( OR = 0.13, 95% CI 0.03 - 0.51, P = 0.003); the rate of perineal incision ( OR = 0.15, 95% CI 0.07 - 0.34, P<0.001), the rate of perineal laceration ( OR = 0.34, 95% CI 0.25 - 0.46, P<0.001), the rate of intact perineum ( OR = 6.30, 95% CI 3.20 - 12.40, P<0.001), and the amount of perineal bleeding ( MD = - 29.72, 95% CI - 43.51 - - 15.93, P<0.001), the difference was statistically significant. Conclusions:Prenatal perineal massage combined with Kegel exercises is a safe, effective and easily implementable intervention method. It is highly effective in preventing perineal injuries and shortening the duration of labor. It not only reduces the risk of postpartum complications but also helps to optimize the delivery experience. Therefore, this combined intervention method can be regarded as one of the important measures for preventing perineal injuries and should be widely promoted in clinical practice.

Objective:To investigate the value of Sequential Organ Failure (SOFA) score and its dynamics (ΔSOFA) in predicting mortality in hematology care unit (HCU) .Methods:A retrospective clinical study was conducted on 79 critically ill hematologic patients admitted to the Center for Critical Care Medicine, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between May and June 2024. SOFA scores and ΔSOFA were calculated within 2 days before and after HCU admission. The predictive value of SOFA and ΔSOFA in mortality was assessed using receiver operating characteristic (ROC) curve analysis.Results:Among the 79 patients, the HCU mortality rate was 54.4%. The SOFA scores on days 1–3 (D1, D2, and D3) and ΔSOFA on day 1 (ΔD_1) of all patients, leukemia patients and hematopoietic stem cell transplantation (HSCT) patients were significantly higher in the death group compared with the non-death group (all P<0.05). ROC curve analysis revealed that the D_1, D_2, D_3 scores, and ΔD_1 significantly predicted mortality ( P<0.001), with areas under the curve (AUCs) of 0.786, 0.866, 0.901, and 0.843, respectively. The sensitivity values were 74.36%, 57.89%, 62.85%, and 86.84%, while specificity values were 70%, 100%, 100%, and 67.65%, respectively. In the HSCT group, the D_-1, D_1, D_2, D_ 3, scores and ΔD_1 were predictive of HCU mortality, with AUCs of 0.833, 0.794, 0.871, 0.846, and 0.795, respectively. Sensitivity values for these scores were 100%, 85.71%, 71.43%, 57.14%, and 57.14%, while specificity values were 73.33%, 70.59%, 91.33%, 100%, and 100%, respectively. In the leukemia group, the D_1, D_2, D_3 scores, and ΔD_1 were predictive of HCU mortality, with AUCs of 0.760, 0.829, 0.846, and 0.756, respectively. Sensitivity values were 71.43%, 78.57%, 53.85%, and 71.43%, while specificity values were 76.19%, 78.95%, 100%, and 63.16%, respectively. For all patients, the D_3 score exhibited the highest specificity, while the ΔD_1 demonstrated the highest sensitivity. For patients in both the HSCT and leukemia groups, the sensitivity and specificity values of the D_1 and D_3 scores exceeded those of the ΔD_1. Conclusion:For patients with hematologic critical illness, including leukemia and those undergoing HSCT hospitalized in the HCU, D_1, D_2, D_ 3 scores and ΔD_1 are significantly associated with HCU mortality.

OBJECTIVE To establish and verify the risk prediction models for postoperative multidrug-resistant or-ganisms(MDROs)infections in the liver transplantation patients based on the machine learning algorithms so as to provide bases for identification of the population at high risk of postoperative MDROs infections.METHODS The liver transplantation patients who were retrospectively collected from intensive care Ⅳ database(MIMIC-Ⅳ)and eICU collaborative research database(eICU)were recruited as the research subjects,meanwhile,the patients who underwent liver transplantation in the First Hospital of Shanxi Medical University from Jan.2021 to Jul.2024 were assigned as the external verification group.The variables were selected by Lasso regression,and the models were established based on 7 types of machine learning algorithms such as extreme gradient boosting algorithm and random forest.The predictive performances of the models were evaluated by comparing the areas under receiver operating characteristic(ROC)curves and the accuracy,the characteristic variables were interpreted by Shapley additive explanations(SHAP),and the risk prediction calculator was established.RESULTS A total of 637 pa-tients were finally enrolled in the study,and the incidence of postoperative MDROs infections was 35.79％.Total-ly 15 variables were finally selected for construction of the model.The area under the receiver operating character-istic curve of XGBoost model was 0.82 for the internal test set,0.78 for the external test set;the predictive per-formance of XGBoost model was better than that of the rest of 6 models.SHAP algorithm indicated that the top 5 important predictive factors were as follows:hepatic encephalopathy,length of intensive care unit(ICU)stay,albumin,model of end-stage liver disease(MELD)and total length of hospital stay.CONCLUSION The risk pre-diction models that are established based on the machine learning algorithms have remarkable effect on prediction of the postoperative MDROs infections and can accurately identify the liver transplantation patients at high risk of postoperative MDROs infections,which may provide guidance for the identification of high-risk population and the development of prevention and treatment measures for infections.

Objective:To explore the application value of the new inflammatory index in predicting the prognosis of patients with liver cirrhosis complicated with esophageal and gastric varices.Methods:This study was a single-center cross-sectional study. Patients who were hospitalized in the Department of Gastroenterology of Minhang Hospital, Fudan University due to liver cirrhosis combined with esophageal and gastric varices from January 2019 to February 2024 were included. All patients were diagnosed clearly based on clinical data, laboratory tests and imaging examination results. According to the results of the first fasting blood routine test after the patient′s admission, the monocyte/lymphocyte ratio (MLR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were calculated. Multivariate Cox regression analysis was used to screen the independent risk factors affecting the prognosis of patients with liver cirrhosis complicated with esophagogastric varices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value of MLR on survival. Kaplan-Meier survival analysis was used to compare the survival differences between patients with MLR>0.33 and those with MLR≤0.33.Results:A total of 177 patients were included, among which 155 were in the survival group and 22 were in the death group. The results of multivariate Cox regression analysis indicated that MLR was an independent risk factor for the prognosis of patients with liver cirrhosis complicated with esophageal and gastric varices [ HR=5.16(95% CI: 1.39-19.15), P=0.014]. The Kaplan-Meier survival curve analysis results showed that the survival rate of patients in the MLR>0.33 group was significantly lower than that in the MLR≤0.33 group (80.90% vs 94.32%, P=0.012). Stratified analysis showed that in patients who did not receive endoscopic intervention, MLR was closely related to prognosis. Conclusions:MLR can be used as an independent risk factor for the prognosis of patients with liver cirrhosis complicated with esophageal and gastric varices, which is helpful for clinicians to conduct risk assessment and thereby formulate personalized treatment strategies.

Objective To systematically evaluate the incidence and influencing factors of axillary web syndrome(AWS)in postoperative breast cancer patients,and to provide evidence for reducing the incidence of axillary web syndrome.Methods A computer search was performed in China National Knowledge Infrastructure(CNKI),VIP,Wanfang,SinoMed,PubMed,Medline,Scopus,The Cochrane Library,Web of Science,Embase,searched for articles on AWS influencing factors of breast cancer published from the establishment of the database to January 6th,2025.The articles were screened according to the inclusion and exclusion criteria.Revman5.4 and Stata17.0 were used for systematic review.Results Fifteen studies involving 3979 breast cancer patients and 1 156 patients with AWS were included.The results of the Meta-analysis showed that there was significant statistical heterogeneity among the included studies(I2=97.0%,P<0.0001).Using the random effects model,the incidence of AWS was 32.2%[95%CI(0.24,0.40),P<0.0001].The influencing factors for AWS after breast cancer surgery are age,body mass index(BMI),total mastectomy,lymph node metastasis,and neoadjuvant chemotherapy.NAC),axillary lymph node dissection(ALND),and the number of harvested axillary lymph nodes.Conclusion The incidence of AWS after breast cancer surgery was high.Clinicians should give early nursing to the influencing factors,reduce the incidence of AWS and improve patients'quality of life after surgery.