This paper reports a 45-year-old female patient with lung squamous cell carcinoma who received chemotherapy for multiple systemic metastases,and then 171 mg of the immune checkpoint inhibitor serplulimab was added,ivd,d1(21 d as a cycle).After 2 cycles of treatment,the patient developed dizziness and nausea,and tumor brain metastasis was considered.The lung CT showed that the irregular mass shadow in the anterior segment of the upper lobe of the right lung was enlarged compared with the previous one,and MRI of the liver showed patchy abnormal signal in the liver segment Ⅳ.PET-CT showed that the lung,liver,adrenal gland,left groin and multiple bones were all progressed compared with the previous progress.It was considered to be tumor hyperprogression caused by serplulimab.Serplulimab was immediately discontinued and methylprednisolone was given for symptomatic treatment,but the patient still died due to overprogression.The Naranjo's Assessment Scale was used to evaluate the correlation between the tumor progression and serplulimab in this case,and the result was' likely to be related'.This case suggested that,the prognosis of tumor hyperprogression caused by immune checkpoint inhibitors has a poor prognosis,the clinical use of immune checkpoint inhibitors should be alert to this situation,and pay attention to early differential diagnosis and timely treatment to avoid serious consequences.

This paper reports a 45-year-old female patient with lung squamous cell carcinoma who received chemotherapy for multiple systemic metastases,and then 171 mg of the immune checkpoint inhibitor serplulimab was added,ivd,d1(21 d as a cycle).After 2 cycles of treatment,the patient developed dizziness and nausea,and tumor brain metastasis was considered.The lung CT showed that the irregular mass shadow in the anterior segment of the upper lobe of the right lung was enlarged compared with the previous one,and MRI of the liver showed patchy abnormal signal in the liver segment Ⅳ.PET-CT showed that the lung,liver,adrenal gland,left groin and multiple bones were all progressed compared with the previous progress.It was considered to be tumor hyperprogression caused by serplulimab.Serplulimab was immediately discontinued and methylprednisolone was given for symptomatic treatment,but the patient still died due to overprogression.The Naranjo's Assessment Scale was used to evaluate the correlation between the tumor progression and serplulimab in this case,and the result was' likely to be related'.This case suggested that,the prognosis of tumor hyperprogression caused by immune checkpoint inhibitors has a poor prognosis,the clinical use of immune checkpoint inhibitors should be alert to this situation,and pay attention to early differential diagnosis and timely treatment to avoid serious consequences.

Objective:To investigate the predictive value of differential distribution of peripheral lymphocyte subsets before and after the first 131I treatment on the therapeutic response to 131I treatment in patients with papillary thyroid cancer (PTC). Methods:A retrospective study was conducted on 46 PTC patients (16 males, 30 females, age 20-77 years) who underwent total thyroidectomy and received 131I treatment between January 2021 and August 2021 in First Hospital of Shanxi Medical University. Peripheral blood lymphocyte subsets (T, B, CD4 + T, CD8 + T, natural killer (NK), helper T (Th)1, Th2, Th17, and regulatory T (Treg) cells) were measured 1-2 d before and 30 d after 131I treatment. Based on serological and imaging evidence, therapeutic response at 6-12 months post- 131I therapy was categorized as either excellent response (ER) or non-excellent response (NER). Differences of preablative stimulated thyroglobulin (psTg) and clinical baseline characteristics between two groups were assessed by using independent-sample t test, paired t test, or Mann-Whitney U test. Predictive value of lymphocyte subsets before and after 131I treatment for therapeutic response was assessed through logistic regression analysis, ROC curve analysis, and decision curve analysis (DCA). Results:In ER group ( n=33) and NER group ( n=13), most lymphocyte subsets showed different degrees of reduction 30 d after 131I treatment compared to before 131I treatment, such as T, B, CD4 + T and Th1 cells in ER group, as well as T, B, CD4 + T, Th1, Th2, Th17, and Treg cells in NER group ( t values: 2.41-9.57, all P<0.05). Before 131I treatment, NER group had significantly higher levels of psTg, Th2, Th17, and Treg cells compared to the ER group ( t values: from -3.32 to -2.48, U=29.00, all P<0.05). After 131I treatment, most of lymphocyte subsets in NER group (T, B, CD4 + T, CD8 + T, Th1 and Treg cells) showed higher trend than those in ER group but without statistical significances ( t values: from -1.12 to -0.06, all P>0.05). Th2 cells before 131I treatment (odds ratio ( OR)=25.00, 95% CI: 1.36-459.10, P=0.030) was identified as a risk factor for NER. ROC curve analysis indicated that AUCs of psTg and Th2 cells for predicting therapeutic response were 0.932 and 0.790, respectively, which was 0.958 for the combined psTg and Th2 cells. DCA showed that within the threshold probability range of 10%-60%, the curves for psTg, Th2 cells, and the combined psTg and Th2 cells were all higher than the extreme curve, suggesting good effect. Conclusions:Most lymphocyte subsets decrease to varying degrees, and NER group shows a significant decrease 30 d after 131I treatment. Th2 cells may be a risk factor for poor response to 131I treatment, providing a certain value in predicting the therapeutic response to 131I treatment.

Patients with type 2 diabetes mellitus (T2DM) typically have a higher risk of cardiovascular diseases, including coronary artery disease (CAD). Currently, the gold standard for diagnosing the severity of coronary artery lesions in T2DM patients is coronary angiography (CAG). This retrospective analysis reviewed data from T2DM patients who underwent CAG at Hengshui People′s Hospital between May 2020 and July 2022. Utilizing multivariate logistic regression analysis, factors associated with the severity of coronary artery stenosis in T2DM patients were identified. Based on these findings, a predictive model was developed to evaluate CAD severity in T2DM patients, incorporating smoking history, elevated triglyceride-glucose (TyG) index, and elevated monocyte to high-density lipoprotein cholesterol ratio (MHR). The combination of the TyG index and MHR model provides insights into coronary artery stenosis severity in T2DM patients, potentially reducing unnecessary invasive CAG procedures.

Objective:To evaluate the efficacy of omalizumab in the treatment of chronic spontaneous urticaria (CSU), and to analyze its influencing factors.Methods:CSU patients treated with omalizumab were prospectively enrolled from the Department of Dermatology, General Hospital of Ningxia Medical University from October 2021 to October 2023. These patients received subcutaneous injections of omalizumab at a dose of 300 mg every 4 weeks (150 mg for patients aged under 12 years) for at least 3 consecutive sessions. Data on general information, blood routine test, and serum total IgE levels were collected, and the 7-day Urticaria Activity Score (UAS7), Urticaria Control Test (UCT), Dermatology Life Quality Index (DLQI), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and the Beck Anxiety Inventory (BAI) were evaluated by dermatologists at baseline, and after 4, 8, and 12 weeks of treatment. A decrease in UAS7 score of ≥ 11 points was defined as good disease control, while a decrease in UAS7 score of < 11 points was defined as poor control. Univariate binary logistic regression and multivariate logistic regression models were used to identify factors influencing the efficacy.Results:A total of 81 CSU patients were enrolled, including 34 males (42.0%) and 47 females (58.0%) ; their ages ranged from 6 to 66 years (39.2 ± 17.9 years), and the disease duration was 42.3 ± 6.9 months; the serum total IgE levels were 249.5 ± 216.3 IU/ml, with 54 patients (66.7%) showing elevated IgE levels (> 100 IU/ml). Compared with baseline levels, the UAS7, DLQI, and CU-Q2oL scores all significantly decreased at weeks 4, 8, and 12, while the UCT scores significantly increased (all P < 0.05). According to the UAS7 change values, 68 patients (83.9%) were well controlled, and 13 (16.1%) were poorly controlled. Univariate logistic regression analysis showed that higher total IgE levels and higher mean platelet volume (MPV) were associated with better efficacy, while higher body mass index (BMI), higher BAI, and the complication of other allergic diseases were associated with poorer efficacy (all P < 0.05). Multivariate logistic regression analysis indicated that BMI, BAI, and MPV significantly affected efficacy: higher MPV was associated with better efficacy ( OR = 3.36, 95% CI: 1.196 - 9.465, P = 0.020), while higher BMI ( OR = 0.76, 95% CI: 0.599 - 0.957, P = 0.016) and higher BAI ( OR = 0.92, 95% CI: 0.870 - 0.985, P = 0.021) were associated with poorer efficacy. During the whole study, only 4 patients (5%) experienced drowsiness, low fever, redness or discomfort at the injection sites, and no serious adverse events were reported. Conclusion:Omalizumab exhibited significant efficacy and high safety in the 12-week treatment of CSU, and BMI and BAI appeared to be risk factors for efficacy, while MPV seemed to be a protective factor affecting efficacy.

Objective:To investigate the expression of X-box binding protein 1 (XBP1) and programmed death-ligand 1 (PD-L1) in cutaneous malignant melanoma (CMM) and their clinical significance. Methods:Fifty-three patients with CMM and fifty-six patients with pigmented nevus were selected from those admitted to the General Hospital of Ningxia Medical University between January 2017 and July 2023. The expression levels of XBP1 and PD-L1 in malignant melanoma tissues and pigmented nevus tissues were detected using immunohistochemic-al staining. The relationships between the expression levels of XBP1 and PD-L1 and the clinical characteristics of patients with CMM were then analyzed. Spearman's analysis was applied to assess the correlation between XBP1 and PD-L1 expression levels in CMM. Results:The expression levels of XBP1 and PD-L1 were significantly higher in CMM tissues than those in pigmented nevus tissues (P<0.05). Elevated XBP1 expression levels in patients with CMM were associated with clinical stages Ⅱ-Ⅳ and tumor-infiltrating lymphocytes (TILs) grade 2-3 (P<0.05). Similarly,elevated PD-L1 expression levels in patients with CMM were associated with ulceration of the primary foci,clinical stages Ⅱ-Ⅳ,Clark grades Ⅳ-Ⅴ,and TILs grades 2-3 (P<0.05). Spearman's analysis demonstrated a positive correlation between XBP1 and PD-L1 expression in CMM (P<0.05). Conclusions:XBP1 and PD-L1 can be used as molecular markers for the diagnosis and evaluation of CMM. Ad-ditionally,XBP1 may affect the development of CMM by regulating the expression of PD-L1,thereby altering the tumor microenvironment.

Objective:To investigate the diagnostic value of an intelligent assisted grading algorithm for nuclear cataract using anterior segment optical coherence tomography (AS-OCT) images.Methods:A diagnostic test study was conducted.AS-OCT image data were collected from 939 cases of 1 608 eyes of nuclear cataract patients at the Shanghai Tenth People's Hospital of Tongji University from November 2020 to September 2021.The data were obtained from the electronic case system and met the requirements for clinical reading clarity.Among them, there were 398 cases of 664 male eyes and 541 cases of 944 female eyes.The ages of the patients ranged from 18 to 94 years, with a mean age of (65.7±18.6) years.The AS-OCT images were labelled manually from one to six levels according to the Lens Opacities Classification System Ⅲ (LOCS Ⅲ grading system) by three experienced clinicians.This study proposed a global-local cataract grading algorithm based on multi-level ranking, which contains five basic binary classification global local network (GL-Net).Each GL-Net aggregates multi-scale information, including the cataract nucleus region and original image, for nuclear cataract grading.Based on ablation test and model comparison test, the model's performance was evaluated using accuracy, precision, sensitivity, F1 and Kappa, and all results were cross-validated by five-fold.This study adhered to the Declaration of Helsinjki and was approrved by Shanghai Tenth People's Hospital of Tongji University (No.21K216).Results:The model achieved the results with an accuracy of 87.81%, precision of 88.88%, sensitivity of 88.33%, F1 of 88.51%, and Kappa of 85.22% on the cataract dataset.The ablation experiments demonstrated that ResNet18 combining local and global features for multi-level ranking classification improved the accuracy, recall, specificity, F1, and Kappa metrics.Compared with ResNet34, VGG16, Ranking-CNN, MRF-Net models, the performance index of this model were improved.Conclusions:The deep learning-based AS-OCT nuclear cataract image multi-level ranking classification algorithm demonstrates high accuracy in grading cataracts.This algorithm may help ophthalmologists in improving the diagnostic accuracy and efficiency of nuclear cataract.

Objective:To evaluate the efficacy of omalizumab in the treatment of chronic spontaneous urticaria (CSU), and to analyze its influencing factors.Methods:CSU patients treated with omalizumab were prospectively enrolled from the Department of Dermatology, General Hospital of Ningxia Medical University from October 2021 to October 2023. These patients received subcutaneous injections of omalizumab at a dose of 300 mg every 4 weeks (150 mg for patients aged under 12 years) for at least 3 consecutive sessions. Data on general information, blood routine test, and serum total IgE levels were collected, and the 7-day Urticaria Activity Score (UAS7), Urticaria Control Test (UCT), Dermatology Life Quality Index (DLQI), Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), and the Beck Anxiety Inventory (BAI) were evaluated by dermatologists at baseline, and after 4, 8, and 12 weeks of treatment. A decrease in UAS7 score of ≥ 11 points was defined as good disease control, while a decrease in UAS7 score of < 11 points was defined as poor control. Univariate binary logistic regression and multivariate logistic regression models were used to identify factors influencing the efficacy.Results:A total of 81 CSU patients were enrolled, including 34 males (42.0%) and 47 females (58.0%) ; their ages ranged from 6 to 66 years (39.2 ± 17.9 years), and the disease duration was 42.3 ± 6.9 months; the serum total IgE levels were 249.5 ± 216.3 IU/ml, with 54 patients (66.7%) showing elevated IgE levels (> 100 IU/ml). Compared with baseline levels, the UAS7, DLQI, and CU-Q2oL scores all significantly decreased at weeks 4, 8, and 12, while the UCT scores significantly increased (all P < 0.05). According to the UAS7 change values, 68 patients (83.9%) were well controlled, and 13 (16.1%) were poorly controlled. Univariate logistic regression analysis showed that higher total IgE levels and higher mean platelet volume (MPV) were associated with better efficacy, while higher body mass index (BMI), higher BAI, and the complication of other allergic diseases were associated with poorer efficacy (all P < 0.05). Multivariate logistic regression analysis indicated that BMI, BAI, and MPV significantly affected efficacy: higher MPV was associated with better efficacy ( OR = 3.36, 95% CI: 1.196 - 9.465, P = 0.020), while higher BMI ( OR = 0.76, 95% CI: 0.599 - 0.957, P = 0.016) and higher BAI ( OR = 0.92, 95% CI: 0.870 - 0.985, P = 0.021) were associated with poorer efficacy. During the whole study, only 4 patients (5%) experienced drowsiness, low fever, redness or discomfort at the injection sites, and no serious adverse events were reported. Conclusion:Omalizumab exhibited significant efficacy and high safety in the 12-week treatment of CSU, and BMI and BAI appeared to be risk factors for efficacy, while MPV seemed to be a protective factor affecting efficacy.

Objective:To investigate the expression of X-box binding protein 1 (XBP1) and programmed death-ligand 1 (PD-L1) in cutaneous malignant melanoma (CMM) and their clinical significance. Methods:Fifty-three patients with CMM and fifty-six patients with pigmented nevus were selected from those admitted to the General Hospital of Ningxia Medical University between January 2017 and July 2023. The expression levels of XBP1 and PD-L1 in malignant melanoma tissues and pigmented nevus tissues were detected using immunohistochemic-al staining. The relationships between the expression levels of XBP1 and PD-L1 and the clinical characteristics of patients with CMM were then analyzed. Spearman's analysis was applied to assess the correlation between XBP1 and PD-L1 expression levels in CMM. Results:The expression levels of XBP1 and PD-L1 were significantly higher in CMM tissues than those in pigmented nevus tissues (P<0.05). Elevated XBP1 expression levels in patients with CMM were associated with clinical stages Ⅱ-Ⅳ and tumor-infiltrating lymphocytes (TILs) grade 2-3 (P<0.05). Similarly,elevated PD-L1 expression levels in patients with CMM were associated with ulceration of the primary foci,clinical stages Ⅱ-Ⅳ,Clark grades Ⅳ-Ⅴ,and TILs grades 2-3 (P<0.05). Spearman's analysis demonstrated a positive correlation between XBP1 and PD-L1 expression in CMM (P<0.05). Conclusions:XBP1 and PD-L1 can be used as molecular markers for the diagnosis and evaluation of CMM. Ad-ditionally,XBP1 may affect the development of CMM by regulating the expression of PD-L1,thereby altering the tumor microenvironment.

Objective To evaluate the ability of contrast-enhanced ultrasound (CEUS) as a prognostic indicator of renal function in chronic kidney disease (CKD) patients.Methods A total of 122 patients with CKD were collected,and patients with allergies to sulfur hexafluoride,pregnancy,cardiopulmonary insufficiency,urinary calculus and tumour were excluded.These patients were divided into estimated glomerular filtration rate [eGFR,ml·min1· (1.73 m2)-1] ≥60 group,eGFR 30-59 group and eGFR ＜ 30 group.CEUS was performed after an intravenous bolus injection of 1.5 ml SonoVue (BR1;Bracco Milan,Italy).Time-intensity curves (TICs) and quantitative indexes were created using QLAB quantification software.Followed up for 2 years,and patients with eGFR dropped 50％,double serum creatinine and end-stage renal disease (ESRD) were regarded as having kidney failure events.Risk factors related to kidney survival were investigated using a multivariate Cox regression model.Results One hundred patients were enrolled in the study,with 78％ patients in CKD 1-2 stages,16％ in CKD 3 stage and 6％ in CKD 4-5 stages.Patients were followed for a mean period of 14.1 months,ten (10％) patients exhibited composite kidney failure events.Among 3 groups,significant differences in the left kidney length derived peak intensity (DPI) were noted (P=0.014,P=0.010).Multivariate Cox regression analysis revealed that the DPI was an independent factor of progression of kidney disease.Multiple linear regression showed that age,basic eGFR,peak intensity were associated with eGFR decline rate.Patients with DPI ＜ 12.27 db were less to recover from kidney disease progression as compared with patients with DPI≥ 12.27 db (P=0.008).The area under the curve (AUC) for DPI was 0.778(95％ CI 0.612-0.944,P＜ 0.05),with a sensitivity of 64％ and a specificity of 88％.Conclusions The DPI might be the most valuable CEUS parameter for the evaluation of renal function.The DPI could serve as an independent predictor of the long-term prognosis of CKD patients.