Objective This study aims to evaluate the diagnostic efficacy of multi-slice spiral CT in early lung cancer and provide evidence for clinical differentiation. Methods A retrospective analysis was conducted on the clinical data of 86 patients with early-stage lung cancer admitted to our hospital between March 2020 and February 2025. All patients underwent MSCT examination. Using pathological examination as the gold standard, the consistency between MSCT and the gold standard was analyzed. CT sign differences among patients with different pathological types of lung cancer were compared. Pearson correlation analysis was used to analyze the relationships between CT signs and the degree of adenocarcinoma infiltration. Results MSCT examination showed positive findings in 75 cases of adenocarcinoma, with a sensitivity of 97.40%, a specificity of 88.89%, a positive predictive value of 98.68%, a negative predictive value of 80.00%, an accuracy of 96.51%, and a Kappa value of 0.823. Significant differences were found in the proportions of tumor maximum diameter > 2 cm, vacuole sign, ground-glass opacity sign, lobulation sign, spiculation sign, air bronchogram sign, pleural indentation sign, and vascular convergence sign (P<0.05), and these proportions increased progressively from carcinoma in situ to minimally invasive adenocarcinoma to invasive adenocarcinoma. Pearson correlation analysis showed that tumor maximum diameter, vacuole sign, ground-glass opacity sign, and pleural indentation sign were positively correlated with adenocarcinoma, while spiculation sign and vascular convergence sign were negatively correlated with adenocarcinoma (P<0.05). Conclusion MSCT demonstrates high diagnostic efficiency for early-stage lung adenocarcinoma and can provide a reference for early clinical evaluation.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

OBJECTIVE To compare the clinical and microbiological characteristics of patients with bloodstream in-fection(BSI)and to summarize the risk factors for death in these patients.METHODS Clinical data of 528 patients with BSI admitted to Xijing Hospital,the Fourth Military Medical University from Jul.2018 to Feb.2023 were collected.The clinical characteristics,pathogens,antibacterial drug therapy and 28-day case-fatality rate of the pa-tients with BSI were analyzed.RESULTS Among the 528 patients with BSI,there were 139 patients with commu-nity-associated infection,69 patients with health care-associated infection,and 320 patients with hospital-associat-ed infection.The predominant pathogens isolated from patients with community-associated infection and health care-associated infection were Escherichia coli(53.96％and 42.03％,respectively),while Klebsiella pneumoni-ae was the main pathogen in patients with hospital-associated infection(24.38％),with a wide variety of major pathogens identified.The drug resistance profiles of E.coli and K.pneumoniae isolated from patients with health care-associated infection were similar to those isolated from patients with hospital-associated infection but were significantly low compared to those isolated from patients with community-associated infection.Compared to pa-tients with community-associated infection,those with health care-associated infection and hospital-associated in-fection had high 28-day case-fatality rates.Thrombocytopenia(HR=1.764,95％CI:1.275-2.440,P=0.001),hypoalbuminemia(HR=2.320,95％CI:1.595-3.374,P＜0.001),coagulation dysfunction(HR=1.605,95％CI:1.141-2.258,P=0.007),procalcitonin＞2.0 ng/ml(HR=3.747,95％CI:1.339-10.485,P=0.012),Charlson comorbidity index ≥5(HR=1.578,95％CI:1.110-2.244,P=0.011)and central ve-nous catheterization(HR=1.848,95％CI:1.322-2.583,P＜0.001)were risk factors for 28-day mortality,while appropriate targeted antibacterial drug therapy(HR=0.399,95％CI:0.291-0.546,P＜0.001)was a protective factor.CONCLUSION Antibacterial drug therapy for patients with health care-associated infection should be guided by their unique pathogens and resistance profiles,and individualized regimens should be devel-oped based on the site and source of infection,regional microbiological characteristics and disease severity to re-duce unnecessary use of antibacterial drug.

OBJECTIVE To compare the clinical and microbiological characteristics of patients with bloodstream in-fection(BSI)and to summarize the risk factors for death in these patients.METHODS Clinical data of 528 patients with BSI admitted to Xijing Hospital,the Fourth Military Medical University from Jul.2018 to Feb.2023 were collected.The clinical characteristics,pathogens,antibacterial drug therapy and 28-day case-fatality rate of the pa-tients with BSI were analyzed.RESULTS Among the 528 patients with BSI,there were 139 patients with commu-nity-associated infection,69 patients with health care-associated infection,and 320 patients with hospital-associat-ed infection.The predominant pathogens isolated from patients with community-associated infection and health care-associated infection were Escherichia coli(53.96％and 42.03％,respectively),while Klebsiella pneumoni-ae was the main pathogen in patients with hospital-associated infection(24.38％),with a wide variety of major pathogens identified.The drug resistance profiles of E.coli and K.pneumoniae isolated from patients with health care-associated infection were similar to those isolated from patients with hospital-associated infection but were significantly low compared to those isolated from patients with community-associated infection.Compared to pa-tients with community-associated infection,those with health care-associated infection and hospital-associated in-fection had high 28-day case-fatality rates.Thrombocytopenia(HR=1.764,95％CI:1.275-2.440,P=0.001),hypoalbuminemia(HR=2.320,95％CI:1.595-3.374,P＜0.001),coagulation dysfunction(HR=1.605,95％CI:1.141-2.258,P=0.007),procalcitonin＞2.0 ng/ml(HR=3.747,95％CI:1.339-10.485,P=0.012),Charlson comorbidity index ≥5(HR=1.578,95％CI:1.110-2.244,P=0.011)and central ve-nous catheterization(HR=1.848,95％CI:1.322-2.583,P＜0.001)were risk factors for 28-day mortality,while appropriate targeted antibacterial drug therapy(HR=0.399,95％CI:0.291-0.546,P＜0.001)was a protective factor.CONCLUSION Antibacterial drug therapy for patients with health care-associated infection should be guided by their unique pathogens and resistance profiles,and individualized regimens should be devel-oped based on the site and source of infection,regional microbiological characteristics and disease severity to re-duce unnecessary use of antibacterial drug.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

The gastric fundus fornix and upper part of the gastric body pose challenges for endoscopic submucosal dissection (ESD), resulting in unsatisfactory resection outcomes for lesions in these areas,because of the difficulty in the endoscope reaching the lesion site. Drawing inspiration from the formation of α loop during flexible colonoscopy and double-channel multibending gastroscope, a single-channel treatment gastroscope was utilized to create a multibending state (referred to as single-channel endoscope multibending method, SCMB). This method was employed to treat 6 patients with lesions in the stomach at Digestive Endoscopy Center of Affiliated Hospital of Nanjing University of Chinese Medicine from June 2021 to December 2021. There were 3 cases in the gastric fundus fornix, 2 cases in the greater curvature on the upper part of the gastric body, and 1 case in the posterior wall of gastric fundus and subcardia. After 2-3 attempts during surgery, SCMB was successfully performed in all cases within 60-120 seconds. All 6 cases completed successful endoscopic resection within 20-80 minutes without significant complications, including 4 cases of ESD and 2 cases of endoscopic full-thickness resection (EFR). Preliminary results indicate that SCMB method during ESD and its derivative technologies are both safe and effective for lesions in challenging areas where gastric ESD is difficult to perform. During surgery, this approach facilitates the front end of endoscope access to the lesion, providing a clear visual field and a stable dissection plane.

Objective:To explore the prognostic factors of primary plasma cell leukemia (pPCL) in the era of novel agents.Methods:The clinical data of 66 patients with pPCL treated at the Department of Haematology, Beijing Chao-Yang Hospital, Capital Medical University from 2011 to 2022 were retrospectively collected to analyze their prognostic factors.Results:Among the 66 patients with pPCL, the median age was 59 (range: 29-79) years. The median overall survival (OS) duration was 19.0 (95% CI 10.4-27.6) months, and the median progression-free survival (PFS) duration was 11.0 (95% CI 6.5-15.6) months. The median OS and PFS were significantly longer in patients with the best post-treatment response of very good partial remission (VGPR) or better than in patients with a response of partial remission (PR) or worse (median OS: 33.0 months vs 6.0 months, P<0.001; median PFS: 16.0 months vs 3.0 months, P<0.001). OS was significantly longer in patients who underwent autologous hematopoietic stem cell transplantation than in those who did not undergo transplantation (49.0 months vs 6.0 months, P=0.002), and there was a trend toward a longer PFS in patients who underwent transplantation than in those who did not undergo transplantation (19.0 months vs 8.0 months, P=0.299). The median OS and PFS were significantly longer in patients who received maintenance therapy than in those who did not receive maintenance therapy (median OS: 56.0 months vs 4.0 months, P<0.001; median PFS: 20.0 months vs 2.0 months, P<0.001). Multivariate analysis showed that hypercalcemia was an independent risk factor ( HR=3.204, 95% CI 1.068-9.610, P=0.038) for patients with pPCL, while receiving maintenance therapy ( HR=0.075, 95% CI 0.022-0.253, P<0.001) and post-treatment response of VGPR or better ( HR=0.175, 95% CI 0.048-0.638, P=0.008) were independent protective factors for patients with pPCL. Conclusions:In the era of novel agents, hypercalcemia, receiving maintenance therapy, and post-treatment response of VGPR or better are independent prognostic factors for pPCL.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.