A 51-year-old male presented with nasal obstruction, followed by progressive hearing loss and blurred vision. Imaging identified space-occupying lesions in the paranasal sinuses, orbits, and paraspinal regions, while laboratory tests confirmed positive anti-proteinase 3 anti-neutrophil cytoplasmic antibody(PR3- ANCA) immunoglobulin G (IgG)and markedly elevated serum IgG4. Despite treatment with corticosteroids, immunosuppressants, and radiotherapy, the patient exhibited steroid dependency with relentless disease progression. Following multidisciplinary consultation, a diagnosis of inflammatory myofibroblastic tumor (IMT) coexisting with ANCA- associated vasculitis (AAV) was favored, though IgG4-related disease remained a critical differential. Ultimately, profound immunosuppression precipitated a severe herpesvirus infection, leading to disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case underscores the rarity and diagnostic complexity of concurrent IMT and AAV, highlights the therapeutic dilemma of balancing primary disease control against fatal opportunistic infections, and emphasizes the critical role of multidisciplinary collaboration in the diagnosis and treatment of complex diseases.

Gorham-Stout disease(GSD) is a rare osteolytic disorder characterized by spontaneous and progressive osteolysis, along with abnormal angiogenesis and lymphangiogenesis, with no new bone formation. We present a case of a 15-year-old female admitted due to " recurrent right leg pain for 5 years, 11 months after undergoing right femoral fracture surgery". Through comprehensive integration of the patient's clinical phenotype, laboratory tests, imaging findings, pathological examinations, and molecular biological test results, GSD was considered highly likely. A multidisciplinary treatment approach was conducted, including a combination of zoledronic acid and sirolimus to inhibit osteolysis, along with rehabilitation training and orthopedic intervention, providing a personalized and comprehensive treatment strategy.

Objective To explore the potential profile of body image and its influencing factors among head and neck cancer patients.Methods Convenience sampling was employed to investigate 335 head and neck cancer patients in a tertiary hospital in Shandong Province from October 2023 to May 2024.Data was collected using the patient's general information questionnaire,Body Image Scale,Medical Coping Modes Questionnaire,Perceived Social Support Scale,Comprehensive Score for Financial Toxicity based on the Patient-Reported Outcome Measures.Latent profile analysis and multivariate Logistic regression analysis were used to explore distinct profiles and influencing factor of body image in head and neck patients.Results A total of 335 valid questionnaires were collected in this study,and 95.4％of the valid questionnaires were included.Body image of patients with head and neck cancer could be divided into 3 latent profiles:body emotional stability(41.5％),body cognitive dissatisfaction(33.7％)and social behavior avoidance(24.8％).Age,location of cancer onset,stage of cancer,surgical treatment,medical coping style(facing coping,yielding coping),social support and economic toxicity were the factors influencing the latent profiles of body image in patients with head and neck cancer(P＜0.05).Conclusion There is heterogeneity in body image of patients with head and neck cancer.Medical staff should implement targeted management strategies based on the influencing factors of different profiles to reduce the body image disorders in patients with head and neck cancer,and to promote patients to better return to society.

ObjectiveTo explore the effects of Kaixuan Jiedu core prescription （KXJD） on sphingolipid metabolism in the mouse model of imiquimod-induced psoriasis-like skin lesions. MethodsThirty-seven male C57BL/6J mice were randomly assigned into five groups： healthy control （n=11）， model （n=11）， methotrexate （MTX， n=5）， low-dose （15.21 g·kg^-1） KXJD （n=5）， and high-dose （30.42 g·kg^-1） KXJD （n=5）. Psoriasis-like skin lesions were induced in mice with 62.5 mg 5% imiquimod cream applied on the back. The KXJD groups and MTX group were treated with 0.2 mL corresponding decoction and MTX， respectively， by gavage daily， while the other groups were given an equal volume of normal saline by the same way. After 5 days of treatment， back skin lesions were collected. Firstly， healthy control and model mice were selected for tandem mass tag （TMT） quantitative proteomics （control vs model=3 vs 3） and targeted lipid metabolomics （control vs model=11 vs 11）. Then， the binding degree between core components and target proteins was predicted via network pharmacology and molecular docking. Finally， an animal experiment was performed to decipher the specific regulation mechanism of KXJD on sphingolipid metabolism. Immunohistochemistry was employed to determine the expression level of sphingosine-1-phosphate （S1P）， and Western blot was employed to determine the expression levels of sphingosine kinase 2 （SPHK2） and monocyte chemotactic protein-1 （MCP-1）. ResultsTMT proteomics and targeted lipid metabolomics suggested that sphingolipid metabolism was active in the psoriatic skin， and key proteases ［serine palmitoyltransferase， long chain base subunit 2 （SPTLC2）， SPHK2， delta（4）-desaturase sphingolipid 1 （Degs1）， and ceramide synthase 4 （CerS4）］ and 8 sphingolipid metabolites （including ceramides， sphingol， sphingomyelin， and glycosphingolipid） expressed abnormally （P<0.05） compared with those in the healthy skin. The molecular docking results indicated that the binding energy between the active components （quercetin， kaempferol， and luteolin） in KXJD and key proteins involved in sphingolipid metabolism was less than-8 kal·mol^-1. Further experimental verification showed elevated expression levels of SPHK2， S1P， and MCP-1 in psoriatic skin compared with healthy skin （P<0.05）， and KXJD down-regulated the expression levels of SPHK2， S1P， and MCP-1 compared with the model group （P<0.05）. ConclusionThis study indicates that there is an imbalance in sphingolipid metabolism in psoriatic skin lesions. KXJD may reduce psoriasis-like lesions in mice by regulating sphingolipid metabolism via the SPHK2/S1P/MCP-1 pathway.

ObjectiveTo explore the effects of Kaixuan Jiedu core prescription （KXJD） on sphingolipid metabolism in the mouse model of imiquimod-induced psoriasis-like skin lesions. MethodsThirty-seven male C57BL/6J mice were randomly assigned into five groups： healthy control （n=11）， model （n=11）， methotrexate （MTX， n=5）， low-dose （15.21 g·kg^-1） KXJD （n=5）， and high-dose （30.42 g·kg^-1） KXJD （n=5）. Psoriasis-like skin lesions were induced in mice with 62.5 mg 5% imiquimod cream applied on the back. The KXJD groups and MTX group were treated with 0.2 mL corresponding decoction and MTX， respectively， by gavage daily， while the other groups were given an equal volume of normal saline by the same way. After 5 days of treatment， back skin lesions were collected. Firstly， healthy control and model mice were selected for tandem mass tag （TMT） quantitative proteomics （control vs model=3 vs 3） and targeted lipid metabolomics （control vs model=11 vs 11）. Then， the binding degree between core components and target proteins was predicted via network pharmacology and molecular docking. Finally， an animal experiment was performed to decipher the specific regulation mechanism of KXJD on sphingolipid metabolism. Immunohistochemistry was employed to determine the expression level of sphingosine-1-phosphate （S1P）， and Western blot was employed to determine the expression levels of sphingosine kinase 2 （SPHK2） and monocyte chemotactic protein-1 （MCP-1）. ResultsTMT proteomics and targeted lipid metabolomics suggested that sphingolipid metabolism was active in the psoriatic skin， and key proteases ［serine palmitoyltransferase， long chain base subunit 2 （SPTLC2）， SPHK2， delta（4）-desaturase sphingolipid 1 （Degs1）， and ceramide synthase 4 （CerS4）］ and 8 sphingolipid metabolites （including ceramides， sphingol， sphingomyelin， and glycosphingolipid） expressed abnormally （P<0.05） compared with those in the healthy skin. The molecular docking results indicated that the binding energy between the active components （quercetin， kaempferol， and luteolin） in KXJD and key proteins involved in sphingolipid metabolism was less than-8 kal·mol^-1. Further experimental verification showed elevated expression levels of SPHK2， S1P， and MCP-1 in psoriatic skin compared with healthy skin （P<0.05）， and KXJD down-regulated the expression levels of SPHK2， S1P， and MCP-1 compared with the model group （P<0.05）. ConclusionThis study indicates that there is an imbalance in sphingolipid metabolism in psoriatic skin lesions. KXJD may reduce psoriasis-like lesions in mice by regulating sphingolipid metabolism via the SPHK2/S1P/MCP-1 pathway.

Objective: To confirm the therapeutic efficacy of the ginkgo biloba extract EGb761 on ischemic stroke and elucidate its underlying mechanism. Methods: Male Sprague-Dawley rats were divided into three groups: sham, model, and EGb761 (ginkgo biloba extract). Ischemic stroke was then simulated in rats via embolic middle cerebral artery occlusion surgery, with the extract administered half an hour before surgery. Neurological deficit scores, infarct volume, cerebral edema rate, and inflammatory factors served as the primary metrics for drug efficacy. Serum metabolites were analyzed using 1H-nuclear magnetic resonance to elucidate the operative mechanism. Results: Treatment with the ginkgo biloba extract EGb761 significantly ameliorated the neurological deficit scores (P = .0343), diminished the cerebral infarct volume (P = .0001) and cerebral edema rate (P = .0030), and alleviated neuroinflammation (all P < .05) in middle cerebral artery occlusion rats. In addition, it significantly altered the contents of various metabolites, such as 2-hydroxybutyrate, isoleucine, isopropanol, isobutyric acid, N6-acetyllysine, glutamate, glutamine, methionine, and N,N-dimethylglycine (all P < .05). Enrichment analysis of the differential metabolites indicated that EGb761 may be involved in the regulation of amino acid metabolism, betaine metabolism, glucose-alanine cycle, Warburg effect, and urea cycle. Conclusion The ginkgo biloba extract EGb761 demonstrates anti-ischemic stroke effect on ischemic stroke model rats by regulating amino acids and amino acid derivatives, such as isoleucine, N6-acetyllysine, glutamate, methionine, and N,N-dimethylglycine.

Objective To explore the predictive value of radiomics for postoperative pancreatic fistula, infection, and long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC). Methods 206 patients who received radical resection of pancreatic cancer in Zhongshan Hospital, Fudan University from January 2014 to December 2020 and were pathologically confirmed as PDAC after surgery were retrospectively selected, all of whom had complete surgical data and long-term follow-up data. Pyradiomics was used to analyze the enhanced CT images of all patients and extract radiomics features. LASSO dimensionality reduction combined with logistic regression analysis was used to construct a predictive model for pancreatic fistula and abdominal infection after PDAC surgery, and evaluating the model’s effectiveness using ROC curves. A long-term survival prediction model for PDAC patients was constructed using LASSO dimensionality reduction combined with Cox regression analysis, and patient risk scores were calculated. The patients were divided into high-risk and low-risk groups based on the median, and the survival curves were compared to evaluate the effectiveness of the model. The imaging omics features with the highest weight were divided into high expression group and low expression group according to the median, and the prognostic differences and clinical features were compared. Radiomics and clinical features were combined to analyze the influencing factors of long-term prognosis and construct a clinical imaging comprehensive model. Results A total of 1 595 radiomics features were extracted. A predictive model for pancreatic fistula and infection after PDAC surgery was constructed, with AUC values of 0.81 and 0.79, respectively. The PDAC long-term survival prediction model was successfully constructed, and the prognosis of the high-risk group was worse than that of the low-risk group (P<0.001). The weight of the radiomics feature “log-sigma-5-mm-3D_glszm_ZonePercentage” was 59.557. The CA19-9 level in the high expression group is higher than that in the low expression group (P=0.017), and there is a statistically significant difference in survival curves between the two groups (P=0.021). The comprehensive clinical imaging model suggested that age, AJCC stage, lymph infiltration, CA19-9 level and imaging characteristics were risk factors for long-term prognosis of PDAC patients (HR=1.028, 4.084, 2.566, 1.232 and 2.536). Conclusions The predictive model based on radiomics has good predictive performance for pancreatic fistula, infection, and long-term prognosis after PDAC surgery. Patients with high expression of the radiomics feature “log-sigma-5-mm-3D_glszm_ZonePercentage” face poorer prognosis.

Objective To systematically evaluate the performance and methodological quality of the risk prediction models for urinary incontinence after radical prostatectomy,so as to provide a reference for selecting the appropriate risk prediction tool.Methods A systematic search was conducted in PubMed,Web of Science,Cochrane Library,CINAHL,EMBASE,CNKI,Wanfang,VIP,and Chinese biomedical literature database from inception to Jan.23,2024.Two researchers independently conducted literature screening and data extraction,and the prediction model risk of bias assessment tool(PROBAST)was applied to assess the risk of bias and applicability of the included studies.MedCalc software was used to perform a meta-analysis of the area under curve(AUC)of the validation groups using the random effect model,and the publication bias and sensitivity analysis were also performed.Results A total of 8 studies were included,with a combined sample size of 7 216 cases.Six models reported the AUC values,and 7 models reported calibration.The applicability of 2 studies was acceptable,while 6 were poor.The most commonly used type of prediction model was logistic regression.After excluding models with extreme AUC values,the random-effects meta-analysis result was 0.840(95%confidence interval 0.786 to 0.895),with no heterogeneity(I2=0%,P=0.737).The bias risk was high in all 8 studies,mainly due to retrospective cohort data,transformation of continuous variables into binary variables,unaddressed missing data,selection of predictors based on univariate analysis,incomplete report of the model discrimination and calibration,and lack of external validation.Egger test result indicated no significant publication bias.Conclusion The development and validation process of the existing risk prediction models for urinary incontinence after radical prostatectomy is still imperfect.Future research should construct prediction models based on multicenter and large-sample data,strengthen the clinical applicability assessment of the models,and strictly follow the reporting standards and procedures,so as to establish high-quality risk prediction models for clinical practice.

Objective To explore the histological and immunohistochemical characteristics of undifferentiated liver cancer in small tissue biopsy specimens.Methods Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)was used to obtain liver tissue strips and cell samples.The tissue and cell morphology of a case of liver undifferentiated carcinoma were analyzed by hematoxylin-eosin staining,immunohistochemical staining,and cell smear techniques.The related literatures of undifferentiated liver cancer were retrieved from PubMed and Wanfang databases to summarize the diagnostic criteria of undifferentiated liver cancer.Results Histologically,this case of undifferentiated liver cancer presented as a patchy arrangement of oval or spindle shaped tumor cells,with large,deeply stained,and distinctly atypical anaplastic cells visible in between.Localized nuclear fission images could be observed.The cytological manifestation was nuclear atypical cells,with less cytoplasm in atypical cells,and some cells had red staining of cytoplasm resembling squamous cell carcinoma cytoplasm.The immunohistochemical results showed epithelial membrane antigen(EMA)(+),cytokeratin(CK)18(+),glutamine synthetase(GS)(-),carbohydrate antigen 19-9(CA19-9)(-),vimentin(-),CK7(-),CK20(-),alpha fetoprotein(AFP)(-),glypican 3(Gpc-3)(-),hepatocellular paraffin antigen-1(Hep-1)(-),and chromogranin A(CgA)(-).The results of literature review showed that undifferentiated liver cancer was more common in middle-aged and elderly men,and generally appeared as isolated circular nodules.In 8 out of 9 cases,tumor cells were observed to grow diffusely under the microscope,and no typical glandular or beam like growth patterns of liver tumors were observed.The malignant degree of tumor cells was high,with 5 out of 9 cases showing significantly atypical interstitial cells.Immunohistochemical features included positive expression of epithelial derived markers(such as pan cytokeratin[CKpan],EMA,and CK18)and negative expression of liver derived markers(AFP,Hep-1,Gpc-3,and arginase-1),which might be accompanied by positive expression of neuroendocrine markers.Conclusion The histological morphology of undifferentiated liver cancer is characterized by diffuse distribution of anaplastic cells,without any glandular or cord like arrangement.The tumor often expresses epithelial derived markers,while liver derived markers show negative expression.

Objective To observe the protective effects of Yiqi Jiedu Decoction on ionizing radiation-induced small intestinal functional injury in mice,and explore whether it alleviates such injury by inhibiting small intestinal ferroptosis,thereby providing scientific support for the discovery and development of intestinal radiation protection drugs in aerospace medicine.Methods A total of 378 male Balb/c mice were randomly divided into 7 groups:blank control group,model group,positive drug group,high-dose Yiqi Jiedu Decoction group,low-dose Yiqi Jiedu Decoction group,Liproxstatin-1 pre-irradiation administration group,and Liproxstatin-1 post-irradiation administration group,with 54 mice in each group.Each group was further divided into 3 batches,with 18 mice per batch.Seven days after preventive administration,all groups except the blank control group were subjected to a single whole-body irradiation with 2.0 Gy 60Co γ-rays.The general condition and morphological structure of the small intestine were observed at 1,3,and 7 days post-irradiation.The small intestinal charcoal propulsion rate,serum D-xylose content,and lactic acid content were measured,along with the levels of Fe,LPO,MDA,GSH,and SOD activity in the small intestine.Results Yiqi Jiedu Decoction could mitigate the decrease in body weight of mice after 2.0 Gy 60Co γ-ray irradiation,improve the morphological structure of the small intestine,reduce the small intestine charcoal propulsion rate,increase serum D-xylose levels,and decrease total serum lactate levels.It also alleviated mitochondrial shrinkage in the small intestine and reduced the contents of Fe and MDA in small intestine tissues.Conclusion Yiqi Jiedu Decoction may alleviate ionizing radiation-induced small intestinal functional injury by inhibiting ferroptosis in the small intestine,providing a new strategy for intestinal radiation injury in deep space exploration missions such as manned spaceflight.