Objective To investigatethe relationship between gastroesophageal reflux disease (GERD) symptoms and clinicopathological characteristics, p53 expression, and survival of Chinese patients with esophageal adenocarcinoma. Methods A total of 3882 patients with esophageal adenocarcinoma, 970 matched patients with esophageal squamous cell carcinoma, and 970 matched patients with gastric cardia adenocarcinoma were included to compare the incidence of GERD symptoms. Patients with esophageal adenocarcinoma were divided into two groups according to the presence and absence of GERD symptoms. The differences in clinicopathological characteristics and p53 expression between the two groups were compared by chi-square test, and the differences in survival between the two groups were compared by landmark analysis. Results The incidence of GERD symptoms increased successively in esophageal squamous cell carcinoma, esophageal adenocarcinoma, and gastric cardia adenocarcinoma. In patients with esophageal adenocarcinoma, the proportions of male, less than 65 years old, lower thoracic tumors, tumors without squamous cell carcinoma, poorly differentiation, early tumors (stage 0-I), and p53-positive tumors in the group with GERD symptoms were higher than those in the group without GERD symptoms; moreover, the long-term survival (≥15 years) was better. Conclusion GERD symptom is an important clinical sign of esophageal adenocarcinoma. It is closely related to specific clinicopathological characteristics, p53 overexpression, and good long-term prognosis.

Objective To investigate the role and mechanism of miR-519d in brain metastasis(BM)of non-small cell lung cancer(NSCLC).Methods RT-PCR was used to detect the expression of miR-519d in normal lung tissues adjacent to cancer,NSCLC lung tissues,NSCLC brain tissues in NSCLC patients with or without BM,human NSCLC cell lines(SK-MES-1,NCI-H226,NCI-H1299,and NCL-H820),normal human bronchial epithelial cells(HBECs),human brain microvascular endothelial cells(HBMECs),and normal human astrocytes(NHA).NSCLC cell line NCI-H1299 was transfected with either miR-519d overexpression lentivirus(OE-miR-519d-LV)or empty vector lentivirus(NC-LV),and set as the OE-miR-519d-LV group and the NC-LV group;cells co-transfected with OE-miR-519d-LV and pcDNA3.1-HER3 were designated as the OE-miR-519d-LV+pcDNA3.1-HER3 group.The cells of the OE-miR-519d-LV group and the NC-LV group were injected intracardially into nude mice to establish an animal model of NSCLC with BM,and the mice were divided into the Ctrl group and the miR-519d group based on the injected cells.Bioluminescence imaging was used to observe NCI-H1299 cell metastasis in the brain of mice.The CCK-8 assay was used to determine the proliferation of NCI-H1299 cells in the OE-miR-519d-LV group and the NC-LV group.An in vitro blood-brain barrier(BBB)model was established using HBMECs and NHA-coated Transwell chambers,and the transendothelial migration ability of NCI-H1299 cells was detected.Western blot was used to detect the expression of epithelial-mesenchymal transition(EMT)-related proteins of MMP-2,MMP-9,E-cadherin,N-cadherin,and Vimentin in each group.Bioinformatics analysis was used to identify the potential binding sites between miR-519d and HER3,and their targeted regulatory relationship was validated by dual-luciferase gene reporter assays.Results Compared with the normal lung tissues adjacent to cancer,miR-519d expression was reduced in the NSCLC lung tissues and NSCLC brain tissues(P<0.05);miR-519d expression was lower in NSCLC brain tissues compared with the NSCLC lung tissues(P<0.05).Compared with HBECs,miR-519d expression was reduced in NSCLC cell lines(P<0.05),with lower levels in NCI-H1299,NCI-H226,and NCL-H820 cells compared with SK-MES-1 cells(P<0.05).Nude mice in the miR-519d group had a lower incidence of BM and longer survival compared with those in the Ctrl group,with statistically significant differences(P<0.05).Compared with the NC-LV group,NCI-H1299 cells in the OE-miR-519d-LV group showed decreases in the proliferation viability,transendo-thelial migration ability,and protein expression of MMP-2,MMP-9,N-cadherin,and Vimentin(P<0.05),and an increase in the protein expression of E-cadherin(P<0.05).miR-519d had a targeted regulatory effect on HER3 protein expression.Compared with the OE-miR-519d-LV group,the migration ability of cells in the OE-miR-519d-LV+pcDNA3.1-HRE3 group was increased(P<0.05),the protein expression of MMP-2,MMP-9,N-cadherin and Vimentin was increased(P<0.05),and the expression of E-cadherin was decreased(P<0.05).Conclusion miR-519d expression is reduced in NSCLC with BM,and its upregulation can inhibit the BM of NSCLC by targeting HER3.

Objective:This study aims to assess the status of catastrophic health expenditure(CHE)among elderly households in China,analyze the evolving inequality trends of CHE,and identify the contributing factors.Methods:Utilizing data from the China Family Panel Studies(2012-2020),we employed Logit regression and multiple linear regression to estimate the factors influencing CHE,Furthermore,we utilized the concentration index and its decomposition method to examine the disparities in CHE and the respective impacts of associated factors.Results:The findings reveal a heightened vulnerability among elderly households,with discernible income-related inequalities and a rising trend.Economic factors.Household savings,per capita income,and net worth,as well as the health status of the elderly and their membership in elderly-oriented organizations,positively contribute to the inequality in catastrophic health expenditure.Conversely,the presence of a partner exhibits a negative influence.Conclusion:These results underscore the need for policy interventions that address these contributing factors and effectively provide economic risk mitigation for the elderly population.

Using the"structure-process-outcome-institution"framework,this article analyzes the conceptual connotation and manifestation of primary care resilience.The mechanism by which digital technologies embedding improve organizational resilience of primary healthcare institution was elucidated;From the resilience perspective,an action framework for reshaping the primary healthcare system by digital technologies was constructed.Research has found that:1)Organizational resilience is the core of primary healthcare resilience.2)Digital technologies mainly promote coupling coordination between resource and organization through promoting change perception,knowledge absorption,and knowledge integration,improve organizational resilience of primary healthcare institution.3)There is a bidirectional interaction between the improvement of organizational resilience and reshaping primary healthcare system;4)The relevant departments should unify instrumental rationality,institutional rationality,and value rationality to establish the embedding,governance,and evaluation framework for digital technologies to reshape the primary healthcare system.

Objective To explore the optimal image-guided verification mode by using combined cone-beam CT(CBCT)and ExacTrac X-ray(ETX)image-guided system for the position verification during the first and remaining fractionated radiotherapy of high-grade glioma patients.Methods Twenty high-grade glioma patients undergoing intensity-modulated radiotherapy at some hospital from January 2018 to June 2020 were analyzed retrospectively.CBCT image-guided system was used for the patients treated for the first time to determine the corresponding position of the treatment center on the body surface and to reset and mark the treatment center,then on-line auto registration of the CBCT images with CT positioning images was carried out,and the residual setup errors were verified with ETX image-guided system;position verification of the setup errors was performed with ETX image-guided sysem during the remaining fractionated treatment.The setup errors and their interval distributionswere calculated for the patients in six directions including left-right direction(Lat),head-foot direction(Lng),anterior-posterior direction(Vrt),rotation around left-right(Pitch),rotation around head-foot(Roll)and rotation around anterior-posterior(Yaw).SPSS 22.0 statistical software was used for data analysis.Results There were 75％patients treated for the first time and 78.62％ones undergoing the remaining fractionated radiotherapy only needed one time of setup error corre-ction.Combined CBCT and ETX image-guided resetting during the first radiotherapy met clinical requirements;during the remaining fractionated radiotherapy there were significant differences between the setup errors in the six directions before and after calibration(P＜0.05).The interval distribution of setup errors showed the error values in the six directions were all restricted within 0 to 1 mm and within 0° to l °during the first and remaining fractionated radiotherapy.Conclusion Involve-ment of combined CBCT and ETX image-guided system in the first and remaining fractionated radiotherapy of high-grade glioma patients after operation contributes to determining and resetting the treatment center rapidly and accurately,decreasing setup errors and enhancing the accuracy and repeatability of radiotherapy.[Chinese Medical Equipment Journal,2024,45(8):57-62].

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To summarize the clinical data of 7 children with activated phosphoinositide 3-kinase delta syndrome(APDS)and enhance understanding of the disease.Methods A retrospective analysis was conducted on clinical data of 7 APDS children admitted to Hunan Provincial People's Hospital from January 2019 to August 2023.Results Among the 7 children(4 males,3 females),the median age of onset was 30 months,and the median age at diagnosis was 101 months.Recurrent respiratory tract infections,hepatosplenomegaly,and multiple lymphadenopathy were observed in all 7 cases.Sepsis was observed in 5 cases,otitis media and multiple caries were observed in 3 cases,and diarrhea and joint pain were observed in 2 cases.Lymphoma and systemic lupus erythematosus were observed in 1 case each.Fiberoptic bronchoscopy was performed in 4 cases,revealing scattered nodular protrusions in the bronchial lumen.The most common respiratory pathogen was Streptococcus pneumoniae(4 cases).Six patients had a p.E1021K missense mutation,and one had a p.434-475del splice site mutation.Conclusions p.E1021K is the most common mutation site in APDS children.Children who present with one or more of the following symptoms:recurrent respiratory tract infections,hepatosplenomegaly,multiple lymphadenopathy,otitis media,and caries,and exhibit scattered nodular protrusions on fiberoptic bronchoscopy,should be vigilant for APDS.[Chinese Journal of Contemporary Pediatrics,2024,26(5):499-505]

Objective To investigate the role of calprotectin S100 A8/A9 complex in evaluating the condition of children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods A prospective study was conducted among 136 children with Mycoplasma pneumoniae pneumonia(MPP)and 30 healthy controls.According to the severity of the condition,the children with MPP were divided into mild subgroup(40 children)and SMPP subgroup(96 children).The levels of S100 A8/A9 complex and related inflammatory factors were compared between the MPP group and the healthy control group,as well as between the two subgroups of MPP.The role of S100 A8/A9 in assessing the severity of MPP was explored.Results The MPP group had a significantly higher level of S100 A8/A9 than the healthy control group,with a significantly greater increase in the SMPP subgroup(P<0.05).The multivariate logistic regression analysis showed that the increases in serum C reactive protein(CRP)and S100A8/A9 were closely associated with SMPP(P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the combined measurement of serum S100 A8/A9 and CRP had an area under the ROC curve of 0.904 in predicting SMPP,which was significantly higher than the AUC of S100 A8/A9 or CRP alone(P<0.05),with a specificity of 0.718 and a sensitivity of 0.952.Conclusions S100 A8/A9 is closely associated with the severity of MPP,and the combination of S100 A8/A9 with CRP is more advantageous for assessing the severity of MPP in children.

A 2-year-and-10-month-old boy presented with multiple masses in the neck and chest for over 3 months.The child had a history of unstable walking,with hard lumps visible at the injury sites after falls,which would resolve on their own.Following a recent injury,a mass was discovered in the posterior neck,protruding above the skin surface and accompanied by limited joint movement.Gradually,new masses were found on the left side of the neck,back near the scapular lower angle,in the scapular fossa,and along the left axillary midline.Magnetic resonance imaging examination showed diffuse low signal on T1-weighted images and high signal on T2-weighted images in the bilateral posterior neck and back muscles two months ago.A CT scan revealed muscle swelling,with areas of patchy low density and multiple nodular high-density ossifications within some muscles.Genetic testing results indicated a mutation in the ACVR1 gene,leading to the final diagnosis of progressive ossifying myositis in this patient.This article summarizes the etiology,diagnosis,and treatment of one case of progressive ossifying myositis,providing a reference for clinicians.

Objective To investigate the expression and prognostic value of serum receptor for advanced glycation end products(RAGE)and CXC-chemokine ligand 16(CXCL16)in patients with sepsis complicated with acute respiratory distress syndrome(ARDS).Methods A total of 234 patients with sepsis diagnosed and treated in a hospital from January 2019 to January 2022 were selected as the study subjects,and were divided into 82 patients with sepsis complicated with ARDS(ARDS group)and 152 patients with sepsis without ARDS(non-ARDS group)according to whether the subjects were complicated with ARDS.ARDS group was divided into survival group(n=50)and death group(n=32)according to the survival status within 28 days of admission.Another 60 healthy subjects who underwent physical examination in the same period were se-lected as the control group.Serum RAGE and CXCL16 levels were detected by enzyme-linked immunosorbent assay.Pearson correlation analysis of serum RAGE and CXCL16 levels with sequential organ failure assess-ment(SOFA)score,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and oxygenation index in patients with sepsis and ARDS.Multivariate Logistic regression analysis of prognostic factors of sep-sis complicated with ARDS.The predictive value of serum RAGE and CXCL16 on the prognosis of sepsis complicated with ARDS patients was analyzed by receiver operating characteristic curve.Results The serum RAGE and CXCL16 levels in ARDS group were higher than those in non-ARDS group and control group,and the serum RAGE and CXCL16 levels in non-ARDS group were higher than those in control group,the differ-ence was statistically significant(P＜0.05).Compared with the survival group,the mechanical ventilation time,intensive care unit stay time,procalcitonin,SOFA score,APACHE Ⅱ score,serum RAGE,CXCL16 lev-els were higher in the death group,and the oxygenation index was lower,with statistical significance(all P＜0.05).The serum RAGE level in patients with sepsis complicated with ARDS was positively correlated with SOFA score and APACHE Ⅱ score(r=0.603,0.671,P＜0.05).Serum CXCL16 levels were positively corre-lated with SOFA score and APACHE Ⅱ score(r=0.655,0.707,P＜0.05).Serum RAGE and CXCL16 were negatively correlated with oxygenation index(r=-0.712,-0.683,P＜0.05).Multi-factor Logistics regres-sion analysis showed that serum RAGE and CXCL16 were independent risk factors for death within 28 days of admission in patients with sepsis complicated with ARDS.The area under the curve(AUC)of combined de-tection of serum RAGE and CXCL16 for predicting death within 28 days of admission in patients with sepsis complicated with ARDS was 0.882,which was higher than that of single index detection of serum RAGE and CXCL16,and the difference was statistically significant(Z=4.450,4.906,P＜0.05).Conclusion The com-bined detection of serum RAGE and CXCL16 is helpful to evaluate the clinical prognosis of sepsis complicated with ARDS patients.