Objective To explore the adverse event signals of children using macrolide drugs （azithromycin, clarithromycin, and erythromycin）, and provide reference for rational medicine use in clinical practice. Methods Data from children under 12 years old were extracted from the US FAERS database spanning from the first quarter of 2004 to the second quarter of 2023. The adverse drug reaction （ADR） signal mining for three macrolide antibiotics was conducted using the Reporting Odds Ratio （ROR） and Bayesian Confidence Propagation Neural Network （BCPNN） methods. Special emphasis was placed on analyzing and contrasting the differences in adverse events among the three drugs. Results A total of 1 615 reports for children under 12 years old were retrieved from the FAERS database, including 1 024 reports of azithromycin, 460 reports of clarithromycin, and 131 reports of erythromycin. Among azithromycin and erythromycin, there were more reports from boys than girls, while for clarithromycin, there were more reports from girls than boys. Oral administration was the most common route of administration for all three drugs. Regarding the outcome of adverse events reported, azithromycin and clarithromycin were primarily associated with other serious adverse events, whereas erythromycin was mainly associated with hospitalization and other serious adverse events. The number of adverse events reported decreased with increasing age, with a higher number of reports in the 0-3 age group. Using the ROR and BCPNN methods for signal detection, 86 signals were identified for azithromycin, 91 for clarithromycin, and 34 for erythromycin. These signals involved 22 System Organ Classes （SOCs）, with azithromycin mainly concentrated in skin and subcutaneous tissue disorders （n=21）, clarithromycin in gastrointestinal disorders （n=15）, and erythromycin in gastrointestinal disorders （n=8）. Twenty-four signals of moderate to high risk were detected, with 13 for azithromycin, 9 for clarithromycin, and 2 for erythromycin. Conclusion The adverse events induced by the three drugs with different risks in different systems. When clinically treating Mycoplasma pneumoniae pneumonia in children, the risk profiles of drugs in different systems should be considered, and personalized dosing should be implemented.

OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective:To evaluate the clinical utility of dual-layer detector CT integrated with virtual monoenergetic imaging (VMI) and an orthopedic metal artifact reduction (O-MAR) algorithm in improving the image quality of patients after lumbar pedicle screw fixation surgery, and to analyze its impact on different types of artifacts and image quality of different tissues.Methods:The study was a prospective study, The study enrolled patients who underwent lumbar pedicle screw fixation at West China Hospital of Sichuan University between March and September 2024. All patients underwent lumbar CT scans using a dual-layer detector system, and four image sets were reconstructed. CLumbar routine scans were performed using dual-layer detector CT, and four image sets were reconstructed:onventional images (CI non-O-MAR), conventional images with O-MAR (CI O-MAR), virtual monoenergetic images (VMI non-O-MAR), and VMI with O-MAR (VMI O-MAR). Objective metrics including artifact index (AI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantified, alongside subjective image quality assessment. One-way ANOVA or Friedman test were used to compare the objective evaluation indicators of image quality between VMI non-O-MAR and VMI O-MAR at different energy levels. Paired t-test or Wilcoxon signed-rank test was used for CI non-O-MAR/VMI non-O-MAR versus CI O-MAR/VMI O-MAR comparisons. Results:A total of 30 patients were included, and all underwent internal fixation with titanium alloy pedicle screws. Objective analysis revealed that in both high-and low-density artifact regions, the AI values of the VMI O-MAR group decreased with the increase of energy levels, and were significantly lower than those of the corresponding VMI non-O-MAR group, with a statistically significant difference (all P<0.001). When the energy level≥140 keV, the AI value of the VMI O-MAR group was simultaneously lower than that of the CI non-O-MAR group and the CI O-MAR group, with statistically significant differences (all P<0.05). The SNR and CNR on the vertebral bodies in the VMI non-O-MAR group and the VMI O-MAR group showed a decreasing trend with increasing energy levels, and were always lower than those in the CI group at high energy levels (100-180 keV) (all P<0.05). At high energy levels (100-180 keV), the SNR of VMI O-MAR in the intervertebral disc and intraspinal tissues was higher than that of the VMI non-O-MAR group, with statistically significant differences (all P<0.05). Compared to other groups, subjective analysis indicated that the 140 keV VMI combined with O-MAR group received the highest image quality scores ( P<0.05). Conclusions:The combined application of VMI and O-MAR technology effectively reduces metal artifacts in post-lumbar fixation CT images. The 140 keV VMI with O-MAR reconstruction provides superior image quality and enhances diagnostic confidence.

OBJECTIVE To analyze the relationship between interleukin-35(IL-35)and serine/arginine-rich splicing factor 6(SRSF6)levels and pleural thickness in patients with tuberculous pleurisy,as well as their values of joint assessment for the risk of pleural tuberculoma.METHODS A total of 100 patients with tuberculous pleurisy admit-ted to the Second Affiliated Hospital of Zhejiang University School of Medicine,Linping Campus,from Jan.2022 to Jul.2024 were selected.The IL-35 and SRSF6 levels in pleural effusion and pleural thickness were measured.The relationship between IL-35,SRSF6 levels and pleural thickness were analyzed.After a one-year follow-up,patients with tuberculosis were divided into the occurrence group and non-occurrence group according to whether pleurotuberculoma developed.The risk factors for developing pleurotuberculoma and the value of IL-35 and SRSF6 in accessing the risk of developing pleurotuberculoma were analyzed.RESULTS In patients with tuberculous pleuri-sy,IL-35 and SRSF6 in pleural effusion was(529.78±146.85)ng/L and(1.44±0.43)ng/ml,respectively,and the pleural thickness was(4.07±0.53)mm.IL-35 and SRSF6 levels in pleural effusion were positively correlated with pleural thickness(P<0.05).Logistic analysis showed that the risk of pleural tuberculoma significantly in-creased in patients with tuberculous pleurisy when there was pleural fluid separation,abnormal pleural thickness and elevated levels of IL-35 and SRSF6 in pleural effusion(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),specificity and sensitivity of combined IL-35 and SRSF6 in predicting the occurrence of pleural tuberculoma in patients with tuberculous pleurisy were significantly higher than those of either marker alone(P<0.05).CONCLUSION IL-35 and SRSF6 levels are positively correla-ted with the pleural thickness of tuberculous pleurisy,and the combined detection of IL-35 and SRSF6 can effec-tively assess the risk of pleural tuberculoma in tuberculous pleurisy patients.

Objective:To explore the effects of IFN-γ on IL-8 secretion by human liver cancer cells and the impact on their malignant biological functions in vitro. Methods:HuH7 and Hep3B cells were treated with different concentrations of IFN-γ for 24 or 48 h. Changes in the cellular activity, IL-8 secretion, and the proportion of CD133 + liver cancer stem cells were evaluated using CCK8 kit and flow cytometry. Western blot was used to detect the effects of IFN-γ on the expression of several molecules such as phosphorylated protein kinase B (p-Akt), phosphorylated c-Jun N-terminal kinase (p-JNK), vimentin, and E-cadherin in the liver cancer cells. Effects of IFN-γ with or without IL-8 on the migration of liver cancer cells were detected by transwell assay. Additionally, effects of IFN-γ combined with IL-8 or IL-8 receptor inhibitor repertaxin on the differentiation of liver cancer stem cells were detected by flow cytometry. One-way analysis of variance and Tukey-Kramer test were used for statistical analysis. Results:HuH7 and Hep3B cells secreted significantly higher levels of IL-8 than normal hepatocytes LO2 ( P<0.01) and high expression level of IL-8 gene ( CXCL8) was closely correlated with the expression levels of vimentin gene ( VIMENTIN), CD133 gene ( PRCM1), PD-L1 gene ( CD274), PD-1 gene ( PDCD1), and CD163 gene ( CD163), as well as the poor prognosis of liver cancer patients ( P<0.01). IFN-γ (1-100 ng/ml) had no significant effect on the proliferative activity of HuH7 and Hep3B cells ( P>0.05), but could significantly inhibit IL-8 secretion, cell migration, CD133 + liver cancer stem cell differentiation and suspension tumor sphere formation through the Akt and JNK pathways ( P<0.01). IFN-γ combined with IL-8 could significantly reversed the inhibitory effects of IFN-γ on liver cancer cell migration, stem cell differentiation, and suspension tumor sphere formation ( P<0.01). IFN-γ in combination with repertaxin could synergistically inhibited the differentiation of CD133 + liver cancer stem cells ( P<0.01). Conclusion:IFN-γ inhibits the differentiation and migration of human liver cancer cells through the Akt/JNK-IL-8 signaling pathway, providing a new strategy for future clinical immunotherapy of liver cancer.

Objective:To explore the association between healthy lifestyle and co-morbidity of overweight/obesity and myopia in adolescents.Methods:Based on the Shanghai Municipal Dynamic Cohort of Student Common Diseases, we used the group-based trajectory model (GBTM) to establish a model for the development of adolescents' healthy lifestyle trajectories aged 11-14 years and the Cox proportional hazard regression model to assess the effects of different healthy lifestyles on the co-morbidity of overweight/obesity and myopia in adolescents.Results:A total of 2 331 adolescents were included in the analysis. The average follow-up time was 1.87 years, with age of (11.44±0.45) years at the initial follow-up, among 1 106 boys and 1 225 girls. During the 2-year follow-up period, the incidence rates of overweight/obesity, myopia, and co-occurrence of overweight/obesity and myopia were 25.9%, 77.0%, and 13.7%, respectively. GBTM identified 3 healthy lifestyles: the unhealthy group (7.3%), the relatively healthy group (50.2%), and the healthy group (42.5%). The risk of overweight/obesity was lower in the relatively healthy group than in the unhealthy group ( HR=0.694, 95% CI: 0.508-0.947). There was no statistically significant association between the GBTM lifestyle subgroups and myopia ( P>0.05). The risk of co-occurrence of overweight/obesity and myopia was lower in both relatively healthy group and healthy group than in the unhealthy group (relatively healthy group: HR=0.515, 95% CI: 0.348-0.763; healthy group: HR=0.571, 95% CI: 0.384-0.849). Sensitivity analyses showed this result to be stable for myopia, overweight/obesity and myopia co-morbidities. Conclusion:Persistent unhealthy lifestyle increases the risk of overweight/obesity and myopia co-occurrence in adolescents.

Objective To evaluate the efficacy and safety of intense pulsed light(IPL)combined with micro-crosslinked hyaluronic acid injected by Shuiguang needle in skin photoaging.Methods Patients with skin photoaging who were treated in Hangzhou Plastic Surgery Hospital from January 2021 to February 2023 were selected.According to the different treatment methods,they were divided into 3 groups:one group was treated with micro-crosslinked hyaluronic acid injected by Shuiguang needle(Shuiguang treatment group),one group was treated with IPL alone[broad band light(BBL)treatment group],and one group was treated with IPL combined with micro-crosslinked hyaluronic acid injected by Shuiguang needle(combined treatment group).The patients were followed up 3 months after treatment.Global scores for photoaging(GSP)were used to evaluate the photoaging degree on the whole face.Global aesthetic improvement scale(GAIS)was used to evaluate the improvement of the overall appearance after treatment.The data of facial wrinkles,texture,pores,brown spots and red areas of patients was collect by using VISIA complexion analysis system.The visual analog scale(VAS)wasused for pain assessment,and adverse effects were recorded.Results GSP score of combined treatment group was lower than that of Shuiguang treatment group and BBL treatment group(P＜0.05).GAIS improvement scores for wrinkles and texture in combined treatment group were higher than those of Shuiguang treatment group and BBL treatment group(P＜0.05),and the GAIS improvement score for pores in combined treatment group was higher than that in BBL treatment group(P＜0.05).The analysis results of VISIA skin test showed that the values of wrinkles and brown spots in combined treatment group after the operation were lower than those in Shuiguang treatment group and BBL treatment group(P＜0.05),and the value of the red area in combined treatment group was lower than that in Shuiguang treatment group(P＜0.05).The effective rates of wrinkle,texture and pore in combined treatment group was 88.2％,94.1％and 94.1％,respectively,higher than those in other two groups.The complications were immediate erythema,acupuncture reaction,and papule,which could be relieved within a few hours.Conclusion IPL combined with micro-crosslinked hyaluronic acid injection in skin photoaging appears to be effective,durable and safety for skin photoaging.

Objective:To explore the value of prenatal three-dimensional ultrasonography（3DUS）in displaying auricular morphotyping and dimensions for predicting congenital aural atresia（CAA）.Methods:A retrospective collection of 227 fetuses who underwent ultrasound scans and retained auricular 3DUS volumes from January 2018 to December 2023 at the First Affiliated Hospital of Sun Yat-sen University was conducted. Fetuses were divided into two groups：a CAA group（52 fetuses，62 auricles）and a non-CAA group（175 fetuses，202 auricles），based on the presence or absence of external auditory canal identified through postnatal examination. According to 3DUS auricular contour and presence or absence of the concha，the auricles were divided into 4 types：type Ⅰ，C-shaped auricle with a concha；type Ⅱ，Irregular auricle with a concha；type Ⅲ，C-shaped auricle without a concha；type Ⅳ，Irregular auricle without a concha. And auricular length（AL）and width（AW）were measured to calculate the product of the auricular length and width（ALW）. Normal reference ranges for ALW from the non-CAA group were developed. Differences of the auricular morphotyping and Z-score of ALW（ALWZ）were compared between the two groups. Receiver operating characteristic（ROC）curves were used to evaluate the diagnostic efficiency of auricular morphotyping，ALWZ and the regression model. A Logistic regression model for CAA based on auricular morphotyping and ALWZ were established.Results:The auricular morphotyping and ALWZ between the two groups were different statistically（both P<0.05）. The AUC of the auricular morphotyping and ALWZ predicting CAA were 0.960（95% CI = 0.923 - 0.997）and 0.975（95% CI = 0.959 - 0.991）individually. Formula for CAA prediction model combining the two indicators（5.379 × morphotyping - 2.386 × ALWZ - Conclusions:The auricular morphotyping and dimensions can effectively predict CAA.

Objective:To develop a deep learning-based artificial intelligence system for assessing image quality in early pregnancy ultrasound，and to evaluate its performance in anatomical structure identification and quality control.Methods:A retrospective study was conducted by collecting 17 910 static ultrasound images of 8 quality-control planes from fetuses at 11 to 13 +6 weeks of gestation who underwent routine first-trimester ultrasound examinations at the First Affiliated Hospital of Sun Yat-sen University from June 2018 to June 2024. The dataset was divided into a training set（12 536 images），a test set（3 582 images），and a validation set（1 792 images）in a 7∶2∶1 ratio to develop a prenatal-screening artificial intelligence system（PSAIS）and to evaluate its performance in the automatic recognition and quality control of standard planes during early pregnancy. The average precision and mean average precision（mAP）were used to measure the model's ability to recognize the anatomical structures on each plane. Intraclass correlation coefficient（ICC）and Kappa statistics were used to assess the consistency between PSAIS and expert-level sonographers in both plane image quality assessment and standardization. The efficiency of PSAIS was also compared to manual quality control. Results:In the test set，the mAP values for recognizing the anatomical structures of the 8 quality-control planes all exceeded 0.800. In the validation set，PSAIS demonstrated moderate to good agreement with two experts in image quality evaluation：the ICC ranged from 0.713 to 0.843 for one expert and 0.678 to 0.788 for the other，while the Kappa values ranged from 0.590 to 0.768 and 0.530 to 0.702，respectively. In terms of plane standardization scoring，PSAIS showed particularly high agreement with expert ratings on the transventricular view（compliance rate 94.6%，Kappa=0.860）and the four-chamber cardiac view with blood flow（compliance rate 94.1%，Kappa=0.778），with agreement above 70% for the remaining planes. Compared with manual quality-control，PSAIS significantly increased processing speed：the total processing time was only 413 seconds，markedly less than the 77 008 seconds and 94 918 seconds required for manual QC（ P<0.001）. Conclusions:The PSAIS system performs well in recognizing and controlling the quality of standard ultrasound planes in early pregnancy，demonstrating high consistency with expert evaluations and significantly improved processing efficiency. It has potential application value in enhancing the quality and efficiency of early pregnancy screening.

Head and neck squamous cell carcinoma(HNSCC)is a highly prevalent malignancy with poor prognosis.Treatment strategies to date have achieved limited success in significantly improving overall survival rates.γδ T cells,a unique subset of immune cells in the tumor microenvironment,can link adaptive and innate immune functions.While γδ T cells can effectively recognize and eliminate HNSCC tumor cells,certain subsets of these cells can secrete interleukin-17,contributing to tumor progression.Nevertheless,due to their remarkable cyto-toxic activity,γδ T cells have been identified as promising candidates for antitumor immunotherapy.This article reviews the biological back-ground of γδ T cells,their role in tumor immunity in HNSCC,and recent advances in γδ T cell immunotherapy,aiming to provide new in-sights into HNSCC diagnosis and treatment.