Objective To evaluate the clinical value of a modified Cancer and Aging Research Group(CARG)model in guiding anticancer drug dose adjustments for elderly cancer patients in China.Methods This prospective study enrolled patients aged≥65 years with solid tumors at the Department of Oncology,Peking Union Medical College Hospital from September 1,2022 to October 29,2023.All patients underwent comprehensive geriatric assessment(CGA)and CARG risk scoring,and were stratified into low-,intermediate-,and high-risk groups.Anti-cancer drug doses(including chemotherapy,targeted therapy or immunotherapy)were reduced proportionally based on CARG risk stratification and treatment intent(curative vs.palliative).Treatment outcomes and adverse events(AEs)were recorded regularly.Fisher's Exact Test compared AE incidence between the CARG-guided dose adjust-ment group(experimental)and the physician-experience-guided dose adjustment group(control).Receiver operating characteristic(ROC)curve analysis was used to assess the predictive value of the CARG model for severe toxicity.Results Among 166 enrolled patients(median age:71 years[range:65-90];78.3%were male;68.7%had gastro-intestinal cancers;69.3%had stageⅣ),95 were assigned to the experimental group(CARG low-risk:24[25.3%],intermediate-risk:51[53.7%],high-risk:20[21.0%])and 71 were included into the control group.By December 31,2024,81 patients experienced disease progression and 10 patients died.Overall AE rates was 92.6%in the ex-perimental group and 94.4%in the control group,while grade≥3 AEs were recorded in 45.3%vs.43.7%,respec-tively(both P＞0.05).Conclusions The modified CARG model-guided dose adjustment strategy achieved comparable safety to empirical dose adjustment,which is in line with the individualized treatment paradigm for elderly cancer pa-tients,representing a structured framework for optimizing therapeutic decision-making in geriatric oncology.

Sj?gren′s syndrome is a chronic autoimmune inflammatory disease characterized by exocrine gland and extraglandular involvement. Cases of Sj?gren′s syndrome-associated aseptic meningitis (SS-AM) are relatively rare, and a case of recurrent aseptic meningitis with leukopenia and mild anemia associated with primary Sj?gren′s syndrome is reported, whose symptoms basically disappeared after treatment with prednison and hydroxychloroquine. The purpose of reporting this case is to raise awareness of SS-AM among fellow clinicians.

Objective:To investigate associations of neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) with carotid plaque and its vulnerability in patients with acute ischemic stroke (AIS).Methods:Consecutive patients with first-ever AIS admitted to the Department of Neurology, the First People's Hospital of Lianyungang from January 1, 2022 to January 31, 2023 were enrolled retrospectively. According to the carotid ultrasound findings after admission, they were divided into a non-plaque group and a plaque group. The latter was further divided into a stable plaque group and a vulnerable plaque group. Multivariate logistic regression analysis was used to evaluate the independent risk factors for carotid plaque and its vulnerability. The odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 369 patients with AIS were enrolled, including 259 males (70.20%), with a median age of 63.00 years (interquartile range, 56.00-70.00 years). There were 20 patients (5.42%) in the non-plaque group and 349 (94.58%) in the plaque group, including 142 (40.69%) in the stable plaque group and 207 (59.31%) in the vulnerable plaque group. Multivariate logistic regression analysis showed that higher NHR ( OR 2.558, 95% CI 1.068-6.126; P=0.035) and higher MHR ( OR 2.312, 95% CI 1.111-4.814; P=0.025) were the independent risk factors for carotid plaques; advanced age ( OR 1.069, 95% CI 1.037-1.103; P<0.001), alcohol consumption ( OR 2.072, 95% CI 1.049-4.092; P=0.036), higher NHR ( OR 1.521, 95% CI 1.146-2.019; P=0.004), and higher MHR ( OR 1.765, 95% CI 1.388-2.244; P<0.001) were the independent risk factors for vulnerable carotid plaques. Conclusion:Higher NHR and MHR are associated with carotid plaque and its vulnerability in patients with AIS.

Objective:To explore the application effect of nursing intervention based on COX's interaction model of client health behavior (IMCHB) in outpatient colonoscopy patients.Methods:Using the convenient sampling method, a total of 209 patients who underwent colonoscopy at the Digestive Endoscopy Center of International Medical Department in Peking Union Medical College Hospital from March 2019 to August 2019 were selected as the research objects. They were divided into the control group (103 cases) and the intervention group (106 cases) according to the order of examination date. The control group received basic nursing intervention according to routine requirements, while the intervention group implemented nursing intervention based on COX's IMCH on the basis of the control group. The medication compliance, occurrence of adverse reactions and satisfaction of patients' experience in medical treatment were compared between the two groups.Results:The medication, diet and exercise compliance of the intervention group during bowel preparation were higher than those of the control group. The incidence of adverse reactions during bowel preparation in the intervention group was better than that in the control group. More patients in the intervention group were willing to undergo colonoscopy again than in the control group. The total satisfaction of the intervention group was higher than the control group. The differences were all statistically significant ( P<0.05) . Conclusions:Nursing intervention based on COX's IMCHB can improve medication compliance of outpatients undergoing colonoscopy, reduce the occurrence of adverse reactions such as nausea and abdominal distension and improve patients' medical experience and satisfaction.

Objective To investigate the association between the angiotensin-converting enzyme (ACE) I/D locus polymor-phism and migraine susceptibility .Methods The case control studies on the relation between ACE I/D gene polymorphism and mi-graine susceptibility published in the databases of PubMed and EMBAE were retrieved .The relationship between ACE 1/D poly-morphism and migraine was evaluated through the effect size (OR) and 95% confidence interval(CI) by fixed-effects model or ran-dom-effect models .Meanwhile the subgroup analysis of ethnicity and migraine types was performed .Results In meta analysis ,the homozygote model(DD vs .Ⅱ:OR= 1 .21 ,95% CI:1 .02-1 .44 ,P=0 .03 ;I2 =47% ) and dominant model all indicated that the ACE I/D polymorphism was positively correlated with the susceptibility of all migraine .The heterozygote model (DI vs .Ⅱ:OR=1 .35 , 95% CI:1 .06-1 .72 ,P=0 .02 ;I2 =10% ) and dominant model (DD+DI vs .Ⅱ:OR=1 .37 ,95% CI:1 .09 -1 .73 ,P=0 .00 ;I2 =40% ) indicated that ACE I/D polymorphism significantly increased the susceptibility of migraine with aura .Conclusion The ACE I/D locus polymorphism is correlated with migraine susceptibility ,its D allele is a risk factor of migraine ,which especially increases the susceptibility of migraine with aura .

MicroRNAs (miRNAs) are a class of non-coding RNAs about 18-25 nucleotides in length,involved in post-transcriptional genes regulation process.Previous studies showed that miRNAs played an important regulatory role in pancreatic development,gene expression,and synthesis and secretion of insulin.A variety of miRNAs which expressed in islet β cells may affect the proliferation and differentiation of islet β cells.Since miRNAs showed tissue specificity,their expression changes were closely related to some diseases.Thus,integrative studies with miRNAs over the essence of syndromes of traditional Chinese medicine could provide new ideas for the treatment of diabetes.

Objective:This study aimed to investigate the effect of human lymphatic endothelial cells (HLECs) on proteins secreted by epithelial ovarian cancer (EOC) cells SKOV3-pm4 with highly directional lymphatic metastasis. Methods:The supernatants of the four groups of cultured cells (A, SKOV3;B, SKOV3+HLEC;C, SKOV3-PM4;and D, SKOV3-PM4+HLEC) were collected. The proteins of these cells were detected by antibody arrays and iTRAQ-2D-LC-MALDI-TOF/TOF/MS. The screened significantly differential proteins were further analyzed by bioinformatics and validated in the human serum and cell culture medium by ELISA. Results:Progranulin (GRN) and vascular endothelial growth factor A (VEGF-A) were upregulated between groups C and A. In addition, insulin-like growth factor binding protein-7 (IGFBP-7) and secreted protein acid rich in cysteine (SPARC) were downregulated between groups D and C. Comprehensive bioinformatics analysis revealed that IGFBP7 interacted with VEGFA. VEGF exhibited the highest expression in ovarian cancer and IGFBP7 exhibited the lowest expression compared with the serum of the normal control group. Statistically significant differences were observed between the two substances. Conclusion:The HLEC microenvironment is closely associated with directional metastasis in lymph nodes with differential proteins, including matricellular proteins and adhesion factors. In particular, the upregulation of VEGFA and GRN and the downregulation of SPARC and IGFBP7 were closely associated with the directional metastasis of EOC cells in lymph nodes.