Objective To compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. Methods A retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1∶1, and the survival of the two groups before and after matching was analyzed. Results A total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged ≥70-80 years and 75 patients aged ≥80-90 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. Conclusion Compared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged ≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.

ObjectiveThis paper aims to analyze the clinical characteristics and medication rationality of liver injury related to Epimedii Folium preparation （EP） and explore the possible risk factors of liver injury， so as to provide a reference for the safe clinical application of Epimedii Folium （EF）. MethodA retrospective analysis was conducted on liver injury cases related to EP from 2012 to 2016. ResultThe number of reported liver injury cases and the proportion of severe cases related to the use of EP show an increasing trend， indicating the objective existence of liver injury caused by EP. There are more cases of liver injury related to EP in women than in men， with an onset age range of 15-91 years old and a median onset age of 60 years old （median onset ages for men and women are 59 and 60 years old， respectively）. The time span from taking EP alone to the occurrence of liver injury is 1-386 days， with a median of 38 days. The time span from taking both EP and Western medicine to the occurrence of liver injury is 1-794 days， with a median of 34 days. EF-related liver injury preparations are mostly composed of traditional Chinese medicines that promote immunity and tonify the liver and kidney， indicating that immune stress in the body may be the mechanism of liver injury caused by the use of EP alone or in combination. There is no increasing trend of toxicity with time or dose in the liver injury caused by EP. By further exploring its risk factors， it is found that patients have unreasonable medication methods such as excessive dosage， repeated use， and multi-drug combination， which may also be one of the important risk factors for EF-related liver injury. ConclusionEP has a certain risk of liver injury and should be emphasized in clinical diagnosis and treatment. Immune stress may be the mechanism of liver injury caused by EP， and in clinical use， it is necessary to be vigilant about the risk of liver injury caused by unreasonable use and combined use with Western medicine.

OBJECTIVE To establish a method for determination cinoxate and other 30 kinds of sunscreen agents in sunscreen cosmetics by HPLC. METHODS Twenty-one fat-soluble sunscreen agents(1#−21#) were ultrasonically extracted by the mixed solution of methanol-tetrahydrofuran(1∶1), 10 kinds of water-soluble sunscreen agents(22#−31#) were ultrasonically extracted by the mixed solution of methanol-tetrahydrofuran-water(2∶3∶5) from the samples. Agilent Zorbax SB C18(4.6 mm× 250 mm, 5 μm) column was used to separate cinoxate and other fat-soluble sunscreen agents(1#−20#), Agilent Zorbax SB C18(2.1 mm× 100 mm, 3.5 μm) column was used to separate polysiloxane-15(21 #) , Waters Symmetry C18(4.6 mm× 250 mm, 5 μm) column was used to separate 10 water-soluble sunscreen agents. Methanol-isopropanol-water, isopropanol-tetrahydrofuran-water, and methanol-acetonitrile-0.02 mol·L−1 ammonium acetate solution(add phosphoric acid to adjust pH to 5.0) were used as mobile phase in gradient elution respectively. The flow rates were 1.2, 0.5, 1.0 mL·min−1. The detection wavelengths were 358nm(7 #, 11 #) , 295 nm(23#−25#, 27#−31#), 311 nm(other components). The injection volumes were 5 µL(polysiloxane-15) and 10 µL(other component), the column temperature was set at 30℃. RESULTS The linear relationships(r>0.9999) of 31 sunscreen agents were good in corresponding concentration range. The limit of detection were in the range of 0.002%−0.02%. The recoveries of two substrates at three different supplemental levels ranged from 92.4% to 110.3%, with the RSDs of 0.02%−4.5%. Forty batches of domestic and imported sunscreen cosmetics were determined by this method, 17 kinds of approved sunscreen agents were detected, of which polysiloxane-15 were detected in 10 batches of samples. By comparing with the current method in Safety and Technical Standards for Cosmetics(2015 edition) , it was found that the extraction efficiency of fat-soluble sunscreen agents was superior to the current method, the stability of drometrizole trisiloxan was improved, cinoxate, polysiloxane-15 and other 7 kinds of sunscreens were added. CONCLUSION This method is accurate, sensitive and reliable, which can be used for the detection and analysis of sunscreen in sunscreen cosmetics.

Objective To study the antifungal effect of demethylzelamaldehyde in vitro. Methods The minimum inhibitory concentrations （MIC） of demethylzeylasteral and fluconazole against 23 fungal strains were determined by micro liquid dilution method. The synergistic index （FICI） of the two drugs was determined using a checkerboard micro liquid dilution method. The synergistic effect of the combination of the two drugs was visually verified by paper diffusion experiments. Finally, the cytotoxicity of demethylzelamaldehyde was determined by CCK-8 method. Results Demethylzelamaldehyde showed a broad spectrum of antifungal activity when used alone, with MICs ranging from 4 g/L to 32 g/L. When combined with fluconazole, the effective concentration of fluconazole could be reduced from over 64 g/L to 0.25 g/L, with FICI values ranging from 0.129 to 0.254, indicating the synergistic effect of the two drugs. The CCK-8 results showed that demethylzeylasteral exhibited cytotoxicity only at concentrations four times higher than the MIC value. Conclusion Demethylzelamaldehyde exhibited good antifungal effect and synergistic effect with fluconazole, and its toxicity was low.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

[摘 要] 目的：本研究旨在探讨融合抗氧化酶GST-SOD1-X-R9（GS1XR）对正常鼻咽上皮细胞NP69的放射防护作用及其可能的机制。方法：培养NP69细胞，分为空白对照（Untr）组、EGFP-GS1组、EGFP-GS1R组和EGFP-GS1XR组，检测0.5 mg/mL不同融合抗氧化酶的跨膜效应。用CCK-8法测定3种融合抗氧化酶在0～1 mg/mL质量浓度范围内的细胞毒性。以DCFH-DA荧光探针测定0～6 Gy X射线和不同剂量（0～1 mg/mL）GS1XR对NP69细胞内ROS水平的影响。进一步实验将NP69细胞分为Untr组、4 Gy X线单纯照射Ctrl组和照射前分别预处理GS1、GS1R、GS1XR及阿米福汀（AMFT，4 μg/mL）组，检测细胞内ROS水平，流式细胞术检测细胞的凋亡率，用WB法检测Nrf2入核量、抗氧化基因GCLC以及抗凋亡因子Bcl-2和凋亡因子BAX的表达。结果：实验结果显示，EGFP-GS1不具备跨膜能力，而EGFP-GS1R和EGFP-GS1XR能够有效跨膜进入NP69细胞（P < 0.000 1）。经24 h处理后，3种融合抗氧化酶均使细胞活力保持在80%以上，其中GS1XR处理组的细胞活力维持在100%以上。4 Gy X射线照射显著增加细胞内ROS水平（P < 0.01），GS1XR以剂量依赖方式清除辐射诱导的ROS。与Ctrl组相比，GS1XR显著降低受照细胞内的ROS水平（P < 0.05），促进Nrf2的入核（P < 0.01），上调抗氧化基因GCLC（P < 0.000 1），降低细胞的凋亡率（P < 0.000 1）和抗凋亡因子Bcl-2（P < 0.001）的表达，并下调促凋亡因子BAX的表达（P < 0.05）。GS1XR的整体保护作用与GS1R相似，且与阿米福汀效果相当。结论：融合抗氧化酶GS1XR对NP69细胞具有显著的放射防护效应，其机制可能与其可进入细胞清除受照细胞内ROS，激活Nrf2信号通路，并调节Bcl-2和BAX的表达有关，GS1XR有望成为一种新型的放射防护剂。

Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we described a case of 2 episodes of subarachnoid hemorrhage with delayed paralysis after kyphoplasty. A 73-year-old man underwent percutaneous kyphoplasty in our hospital an osteoporotic vertebral fracture at the T12 level. On the 55 h after kyphoplasty for T12 osteoporotic vertebral fracture, he developed paralysis of the lower limbs. An emergency posterior decompression from T8 to L2 was performed. And the subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. However, 2 weeks after the operation, the patient experienced a setback with severe neurological decline (paraplegia with sensory and autonomic dysfunction). An emergency posterior decompression from T5 to L2 was performed. The subarachnoid hematomas were removed. This case reflects the cause and progression of spinal subdural hematoma. Previous literature has debated the best treatment approach for spinal subarachnoid hemorrhage, but the prognosis of patients is heavily dependent on precise symptom evaluation and localization.

Purpose: The prognosis of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) is extremely poor, and systemic therapy is currently the mainstream treatment. This study aimed to assess the efficacy and safety of lenvatinib combined with anti–programmed cell death-1 antibodies and transcatheter arterial chemoembolization (triple therapy) in patients with HCC and PVTT. Materials and Methods: This retrospective multicenter study included patients with HCC and PVTT who received triple therapy, were aged between 18 and 75 years, classified as Child-Pugh class A or B, and had at least one measurable lesion. The overall survival (OS), progression-free survival (PFS), objective response rates, and disease control rates were analyzed to assess efficacy. Treatment-related adverse events were analyzed to assess safety profiles. Results: During a median follow-up of 11.23 months (range, 3.07 to 34.37 months), the median OS was greater than 24 months, and median PFS was 12.53 months. The 2-year OS rate was 54.9%. The objective response rate and disease control rate were 69.8% (74/106) and 84.0% (89/106), respectively; 20.8% (22/106) of the patients experienced grade 3/4 treatment-related adverse events and no treatment-related deaths occurred. The conversion rate to liver resection was 31.1% (33/106), with manageable postoperative complications. The median OS was not reached in the surgery group, but was 19.08 months in the non-surgery group. The median PFS in the surgery and non-surgery groups were 20.50 and 9.00 months, respectively. Conclusion Triple therapy showed promising survival benefits and high response rates in patients with HCC and PVTT, with manageable adverse effects.

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34⁺⁰ weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.
Infant ; Infant, Newborn ; Humans ; Birth Weight ; Intensive Care Units, Neonatal ; Retrospective Studies ; Tertiary Care Centers ; Infant, Extremely Low Birth Weight ; Gestational Age ; Infant, Extremely Premature ; Sepsis/epidemiology* ; Retinopathy of Prematurity/epidemiology* ; Bronchopulmonary Dysplasia/epidemiology*

Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.
Adult ; Humans ; Adolescent ; Imatinib Mesylate/adverse effects* ; Incidence ; Antineoplastic Agents/adverse effects* ; Retrospective Studies ; Pyrimidines/adverse effects* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy* ; Treatment Outcome ; Benzamides/adverse effects* ; Leukemia, Myeloid, Chronic-Phase/drug therapy* ; Aminopyridines/therapeutic use* ; Protein Kinase Inhibitors/therapeutic use*