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.

Renal Fanconi syndrome (FS) is a rare renal manifestation of primary Sjögren's syndrome (pSS). This study aims to analyze the clinical and prognostic characteristics of patients with pSS-associated renal FS (pSS-FS) and provide insights for clinical management.

Rheumatoid arthritis belongs to arthralgia in the theory of traditional Chinese medicine, with cold dampness obstruction pattern (CDO) and damp heat obstruction pattern (DHO) as the main pattern types. Fine therapeutic effects have been obtained in clinical practice following the differentiation of CDO and DHO. However, suitable animal models are not available currently. For adapting to the clinical diagnosis, as well as carrying out basic research of integrated Chinese and Western medicine and preclinical study on new Chinese medicine in a better way, the “Guidelines for Establishing Animal Models of Rheumatoid Arthritis with Cold Dampness Obstruction Pattern and Damp Heat Obstruction Pattern” (referred to as “Guidelines”) were compiled by our research group in cooperation with renowned experts in clinical, pharmaceutical, zoological, and methodological research fields. According to the theory of disease and syndrome integration, experts standardized the establishment methods for animal models of rheumatoid arthritis with CDO and DHO. The Guidelines were compiled via the nominal group method according to the principle of evidence coming in main place, consensus as the auxiliary, and experience as the references. Contents such as animal species, arthritis induction methods, external stimulation conditions, and assessment indicators were specified in the Guidelines based on the comprehensive evaluation of pathogenesis homology, behavioral phenotypic consistency, and drug therapy predictability between animal models and human diseases. The Guidelines will be applicable to the research on syndromes in rheumatoid arthritis, elucidation of acting mechanism, and development of new medicine, and provide reference for standardizing other types of animal models with the integration of disease and syndrome, to promote the modernization of Chinese medicine research.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

OBJECTIVE To analyze the current status of hospital-acquired infections(HAI)in cancer patients in Henan Cancer Hospital,and explore the application of Case Mix Index(CMI)based on disease diagnosis-related groups(DRG)in the evaluation of HAI risks.METHOD Data on HAI of patients in cancer hospitals in Henan Province from Jun.2023 to Jun.2024 were statistically analyzed,including incidence rates,distribution of infec-tion sites and composition ratios of pathogens,high-risk departments were identified by CMI-adjusted 1 000-day incidence rates of HAI infections,and the current status of HAI in cancer patients were analyzed.RESULTS The incidence of HAI in cancer patients was 1.67％(4 315/259 087),and the incidence rate of HAI in 1 000 days was 2.46 per 1000.The sites of infection were mainly the respiratory tract,the abdominal cavity,the surgical sites and the bloodstream.A total of 2 381 strains of pathogens were cultured and isolated,including 1 570 strains of gram-negative bacteria,638 strains of gram-positive bacteria and 173 strain s of fungi,and the top five strains de-tected were Escherichia coli(24.49％),Klebsiella pneumoniae(15.41％),Pseudomonas aeruginosa(9.11％),Staphylococcus aureus(8.86％)and Staphylococcus epidermidis(4.66％).After CMI adjustment,the order of decreasing was dominated by surgical departments,while the order of increasing was dominated by non-surgical departments,and the top five departments with the highest adjusted incidence rates were Orthopedics and Soft Tissue department,Hematology department,Hepatobiliary Surgery department,General Surgery department and Urology department.CONCLUSIONS In the prevention and control of HAI in cancer patients,attention should be given to the gram-negative bacteria,and close monitoring of infections in the respiratory tract,abdominal cavity,and surgical sites is essential.This study uses the CMI to adjust the HAI incidence rate of cancer patients in order to identify high-risk departments that currently require focused management,it also analyzes the DRGs codes with a highest proportion of HAI in each department,with a particular focus on patients in these high-risk groups,and it aims to avoid and minimize the occurrence of HAI among cancer patients as much as possible through refined DRGs analysis and targeted prevention and control measures.

Objective:To establish a mouse model of liver cancer resistant to PD-1 monoclonal antibody and analyze the changes in its metabolomics to explore the potential mechanism of drug resistance.Methods:BALB/c mice were randomly divided into control and treatment groups after being loaded with tumor,and a normal group was additionally set up.The normal and control groups were injected with saline,and the treatment group was injected with PD-1 monoclonal antibody,after which the mice in the treatment group were screened for drug resistant and response groups.Observed the drug-resistant situation,body mass,tumor growth and survival rate of mice in each group,calculate the spleen index.The pathological features of tumor tissues were observed by HE staining method.Serum metabolites were detected by non-targeted metabolomics.Finally,a bivariate Pearson correlation analysis was conducted between the differential serum metabolites and tumor size.Results:The tumor-bearing mouse model with PD-1 monoclonal antibody resistance was successfully established,and the drug resistance rate of the mice was 50％.Compared with the normal and response groups,mice in the resistant group showed an increase in body weight,a significant increase in tumor volume,a decrease in survival rate,and a significant increase in splenic index.There was less lymphocyte infiltration in the tumor tissue.Metabolomics analysis showed that the serum levels of glutamic acid and aspartic acid increased and malic acid decreased in the resistant mice compared with the response group,and these changes were closely related to the arginine biosynthesis pathway.Conclusions:The tumor-bearing mouse model with PD-1 monoclonal antibody resistance was successfully established.The changes in its peripheral serum metabolomics mainly involve arginine metabolism and the related changes of aspartate,malate and glutamate.

Objective:To investigate the relationship between visual recovery and non-treponemal serologic test titers [tolulized red unheated serum test (TRUST) or rapid plasma reagin (RPR)] in patients with isolated ocular syphilis and those with ocular syphilis combined with neurosyphilis.Methods:A total of 35 ocular syphilis patients treated at the Department of Ophthalmology, the First Affiliated Hospital of Soochow University, and the Department of Dermatology, the Fifth People′s Hospital of Suzhou between 2016 and 2024 were enrolled. Pre-treatment serum TRUST/RPR and treponema pallidum particle agglutination (TPPA) assay results were collected for all 35 patients. Cerebrospinal fluid (CSF) biochemical, routine, TRUST/RPR, and TPPA results were obtained for 29 patients. Visual acuity (logMAR) before and after treatment was recorded for 21 patients (34 eyes). Pearson or Spearman correlation analysis was used to assess the relationship between pre-and post-treatment visual acuity, degree of visual recovery, and serum titers.Results:No significant differences in titer distribution were observed among the 35 ocular syphilis patients based on age or sex ( P>0.05). Among the 29 patients who underwent lumbar puncture, 17(58.62%) were diagnosed with ocular syphilis combined with neurosyphilis, while 12(41.38%) had isolated ocular syphilis. The proportion of patients with high pre-treatment serum titers did not differ significantly between the two groups ( P=0.294). The degree of post-treatment visual recovery showed a positive correlation with pre-treatment serum titers, indicating that higher initial titers were associated with better visual recovery (34 eyes, r=-0.302, P=0.081). Post-treatment visual acuity was positively correlated with pre-treatment visual acuity (34 eyes, r=0.547, P=0.001), suggesting that patients with poor baseline vision had worse post-treatment visual outcomes. The median visual improvement was logMAR 0.560 in the isolated ocular syphilis group and logMAR 0.202 in the neurosyphilis-combined group, with no significant difference between the two ( P=0.322). Conclusions:Ocular syphilis patients with higher pre-treatment titers exhibit better visual recovery, while poor post-treatment visual outcomes are associated with low baseline visual acuity.

This paper aims to discuss the application value and progress of artificial intelligence (AI) in the diagnosis and treatment of gastrointestinal tumors and teaching practice of gastrointestinal oncology. Through a comprehensive analysis of the current clinical research status and literature, this paper summarizes the application practice and exploratory thinking of AI and deep learning technologies in gastrointestinal oncology. In diagnosis, AI technologies have improved the early detection and diagnosis efficiency for gastrointestinal tumors by optimizing medical image analysis, especially in the recognition of liver metastases. Applications of AI in pathological diagnosis include automatic recognition of tumor cells and tissue structure, as well as improving diagnostic sensitivity and specificity through feature extraction and pattern recognition. In treatment, the application scenarios of AI include rapid diagnosis, accurate staging, personalized treatment plan formulation, drug development, and surgical assistance. In surgical assistance, AI technology improves the safety and effectiveness of surgery through preoperative evaluation, surgical navigation, and postoperative evaluation. In teaching, AI technology facilitates knowledge acquisition and clinical skill enhancement of medical students by providing a multidisciplinary learning platform, simulating clinical environment and case details, and establishing a remote learning platform. The application of AI technology in teaching also includes deep learning and assessment feedback, providing personalized teaching and real-time assessment for students. This paper discusses the application prospects for AI technology in the teaching practice of gastrointestinal oncology. Although AI technology shows great potential in the diagnosis and treatment of gastrointestinal tumors and teaching gastrointestinal oncology, it also has limitations and needs to be combined with traditional teaching methods to achieve the best teaching results.

Objective To compare the effects of dexmedetomidine and midazolam on intraoperative blood pressure and postoperative 90-day outcome of endovascular treatment(EVT)in patients with acute anterior circulation large vessel occlusive stroke.Methods Retrospective consecutive patients with acute anterior circulation large vessel occlusion stroke who received EVT within 24 hours of onset,admitted to the Department of Neurology at the Second People's Hospital of Hefei from January 2024 to February 2025 were included.Patients were divided into the dexmedetomidine group and the midazolam group based on the choice of sedative in EVT.Baseline and clinical data were collected from patients,including sex,age,medical history(hypertension,diabetes,atrial fibrillation,stroke history),smoking history,blood pressure at admission(systolic,diastolic,mean arterial pressure),National Institutes of Health stroke scale(NIHSS)score at admission,trial of Org 10172 in acute stroke treatment(TOAST)classification,and site of vascular occlusion(internal carotid artery,M1 segment of the middle cerebral artery).Procedure related parameters,including intravenous thrombolysis before EVT,intraoperative use of tirofiban,modified thrombolysis in cerebral infarction(mTICI)grade,thrombectomy techniques(stent-retriever thrombectomy,aspiration thrombectomy,combined stent-retriever and aspiration thrombectomy,and other salvage measures),number of thrombectomy,time from onset to revascularization,time from puncture to revascularization,blood pressure during EVT(minimum systolic,minimum diastolic,and minimum mean arterial pressure),and blood pressure at the end of EVT(systolic,diastolic,and mean arterial pressure).The primary outcome was good prognosis at 90 days after EVT(modified Rankin scale score of 0-2 at 90 days),while secondary outcome was＞20％decrease in mean arterial pressure during EVT,early neurological improvement(ENI;a decrease on NIHSS score no less than 8 or a reduction of NIHSS score to 0-1 at 24 hours after EVT),and early neurological deterioration(END;an increase of more than 2 points on the NIHSS at 24 hours after procedure).Safety outcomes included any intracranial hemorrhage within 48 hours after EVT,symptomatic intracranial hemorrhage within 48 hours after EVT(sICH;intracranial hemorrhage confirmed by head CT leading to neurological deterioration,with an increase in NIHSS score of at least 4 points,or the presence of potentially fatal intracranial hemorrhage on head CT),pneumonia within 2 weeks after EVT,and the 90-day mortality after EVT.The baseline and clinical data,EVT conditions,primary outcome,secondary outcome,and safety indicators were compared between the two groups.Univariate Logistic regression analysis was used to screen the variables associated with a decrease in mean arterial pressure＞20％during EVT in patients with acute anterior circulation large vessel occlusive stroke.Variables with P＜0.15 and those considered potentially influential based on clinical experience were included in multivariate Logistic regression analysis to identify predictors of a＞20％decrease in mean arterial pressure during EVT in patients with acute anterior circulation large vessel occlusive stroke.Results A total of 93 patients with acute anterior circulation large vessel occlusive stroke who underwent EVT were included,comprising 51 males and 42 females,aged 34 to 99 years,with an average of(71±13)years old.Among them,63 patients were in the dexmedetomidine group,and 30 patients were in the midazolam group.33 patients showed＞20％decreases in mean arterial pressure during EVT,while 60 patients had ≤20％decreases.(1)Compare with the midazolam group,the proportion of female patients in the dexmedetomidine group was lower(36.5％[23/63]vs.63.3％[19/30],P=0.015),and the age was younger([69±13]years vs.[77±13]years,P=0.005).There were no statistically significant differences in other baseline and clinical data(all P＞0.05).(2)In comparison with the midazolam group,the dexmedetomidine group had a higher proportion of patients with more thrombectomy procedures(1.00[1.00,2.00]times vs.1.00[1.00,1.25]times,P=0.011),END(27.0％[17/63]vs.6.7％[2/30],P=0.023),sICH within 48 hours(19.0％[12/63]vs.3.3％[1/30],P=0.041),and a decrease in mean arterial pressure＞20％during EVT(42.9％[27/63]vs.20.0％[6/30],P=0.031).There were no statistically significant differences in the remaining EVT conditions,primary outcome,secondary outcome,and safety indicators(all P＞0.05).(3)The results of univariate Logistic regression analysis showed that diastolic blood pressure at admission(P=0.002),mean arterial pressure at admission(P=0.009),and dexmedetomidine sedation(P=0.036)were the influencing factors of a decrease＞20％in mean arterial pressure during EVT in patients with acute anterior circulation large vessel occlusion stroke.(4)The results of multivariate Logistic regression analysis showed that dexmedetomidine sedation(OR,3.271,95％CI 1.057-10.126,P=0.040)and higher diastolic blood pressure on admission(OR,1.105,95％CI 1.006-1.213,P=0.037)were independent predictors of a decrease over 20％in mean arterial pressure during EVT in patients with acute anterior circulation large vessel occlusive stroke.Conclusions Dexmedetomidine is an independent predictor of an over 20％decrease in mean arterial pressure during EVT in patients with acute anterior circulation large vessel occlusive stroke,but there is no statistically significant differences in the rate of good neurological function at 90 days and 90-day mortality postoperatively between the two groups.Further prospective randomized controlled studies are needed.

Objective To evaluate the correlation between soluble programmed cell death-ligand 1(PD-L1)and clinical features of patients with unstable angina pectoris(UAP),and analyze its correlation with prognosis.Methods A total of 171 UAP patients treated in our hospital from April 2021 to October 2023 were recruited retrospectively,and according to adverse cardiovascular events occurred or not within 6 months of follow-up,they were divided into good prognosis group(137 cases)and poor prognosis group(34 cases).Fasting venous blood sample of 4 ml was collect-ed to detect the levels of soluble PD-L1,LDL-C,HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10 and TNF-α.Pearson correlation analysis was used to analyze the correlation between soluble PD-L1 level and clinical features of the UAP patients,and logistic regression model was employed to evaluate the correlation between soluble PD-L1 and the occurrence of adverse cardiovascular events in the UAP patients.ROC curve analysis was applied to evaluate its performance in predicting the clini-cal prognosis,and its AUC value was calculated.Results The poor prognosis group had signifi-cantly lower LDL-C level and LVEF value,but higher levels of HDL-C,hs-CRP,hs-cTnI,IL-6,IL-10,TNF-α and soluble PD-L1 than the good prognosis group(P＜0.05,P＜0.01).Pearson cor-relation analysis showed that soluble PD-L1 level was positively correlated with hs-CRP level(r=0.502,P=0.000).Multivariate logistic regression analysis indicated that the levels of hs-CRP,hs-cTnI and soluble PD-L1 were independent influencing factors for major cardiovascular adverse events in the UAP patients(OR=2.872,95％CI:1.069-7.717,P=0.036;OR=1.667,95％CI:1.022-2.717,P=0.040;OR=1.152,95％CI:1.023-1.297,P=0.019).ROC curve anal-ysis revealed that soluble PD-L1 had high predictive value for clinical prognosis of UAP patients,with an AUC value of 0.942,a sensitivity of 82.35％and a specificity of 94.16％.Conclusion The increased level of soluble PD-L1 increases the risk of major adverse cardiovascular events in UAP patients.Soluble PD-L1 can be used as a potential new biomarker to predict the clinical prognosis of patients.