Objective　To explore the clinical characteristics and drug resistance of Elizabethkingia meningoseptica (EM) nosocomial infection, so as to provide evidence for prevention of EM nosocomial infection and guiding the rational use of antibiotics. Methods　A retrospective study was conducted of 67 patients with EM infection in a tertiary hospital from January 2021 to December 2022. The infective characteristics and drug resistance were analyzed. Results　The cohort of 67 EM-infected patients was predominantly males aged ≥60 years, with the most frequent source being the first district of the intensive care unit (ICU), followed by the respiratory medicine and emergency department (19.40%, 13/67). The specimens were mainly isolated from respiratory tract (86.57%, 58/67), of which sputum accounted for 49.25% (33/67), and alveolar lavage fluid accounted for 37.31% (25/67). The majority of EM infections occurred in patients with pre-existing respiratory conditions (49.25%, 33/67), who generally experienced prolonged hospital stays and underwent invasive procedures, such as mechanical ventilation 94.03% (63/67), urinary catheterization (95.52%, 64/67), and central venous catheterization (97.01%, 65/67). Post-treatment, the improved rate of the 67 patients was 40.30% (27/67). Susceptibility testing demonstrated a high resistance rate of EM to cefoperazone-sulbactam, 98.39% (61/62), contrasted by significant susceptibility to compound trimethoprim-sulfamethoxazole (TMP-SMX)/cotrimoxazole, doxycycline, minocycline, and piperacillin-tazobactam, with susceptibility rates exceeding 90%. Conclusions　The patients infected with EM were almost elderly men with certain underlying diseases, experienced prolonged hospital stays, and had a history of invasive operations. The specimens of EM were mainly from Intensive Care Unit and isolated from respiratory tract. The strain showed high resistance to cefoperazone-sulbactam, whereas it remained highly susceptible to cotrimoxazole, doxycycline, minocycline and piperacillin-tazobactam, which may be considered as first-line treatment options.

Objective:To explore the efficacy and safety of immunoneoadjuvant therapy with pembrolizumab combined with chemotherapy in locally advanced resectable hypopharyngeal squamous cell carcinoma patients.Methods:This study was a prospective, single arm, single center clinical study that was opened for enrollment in April 2021. Patients who met the inclusion criteria at the Cancer Hospital of the Chinese Academy of Medical Sciences were treated with neoadjuvant therapy of pembrolizumab combined with cisplatin and paclitaxel, and after treatments, received surgery and postoperative adjuvant therapy. The main endpoint of this study was postoperative pathological complete response (pCR), and other observations included adverse reactions and long-term prognoses of patients after neoadjuvant therapy.Results:By September 2023, a total of 23 patients who underwent neoadjuvant therapy and surgery were enrolled in the study and all patients were males aged 49-74 years. All patients were locally advanced stage, including 3 patients in stage Ⅲ and 20 patients in stage Ⅳ. There were 12 cases of primary lesions with posterior ring involvement accompanied by fixation of one vocal cord and 20 cases of regional lymph node metastases classified as N2. Eighteen cases received a two cycle regimen and 5 cases received a three cycle regimen for neoadjuvant therapy. The postoperative pCR rate was 26.1% (6/23), with no surgical delay caused by adverse drug reactions. The laryngeal preservation rate was 87.0% (20/23). Pharyngeal fistula was the main surgical complication, with an incidence of 21.7% (5/23). The median follow-up time was 15 months, and 3 patients experienced local recurrence.Conclusions:The immunoneoadjuvant therapy of pembrolizumab combined with chemotherapy has a high pCR rate in locally advanced resectable hypopharyngeal squamous cell carcinoma, with increased laryngeal preservation rate and no significant impact on surgical safety.

Objective:To explore the correlation between MYB/NFIB gene fusion and clinicopathological features such as tumor grade and prognosis of head and neck adenoid cystic carcinoma (ACC), and to assess the concordant rate of fluorescent in situ hybridization (FISH) with MYB and NFIB immunohistochemistry.Methods:FISH detection of MYB/NFIB gene fusion was performed on 48 head and neck ACC cases and 15 non-ACC salivary gland tumors at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China during April 2014 and January 2020. ACC cases were divided into grade Ⅰ-Ⅱ, grade Ⅲ and high-grade transformation, according to pathological grading criteria. Prognosis, FISH results and other clinicopathological characteristics were analyzed. MYB and NFIB immunohistochemistry was performed on the 48 ACC and 15 non-ACC cases. The diagnostic accuracy of FISH and immunohistochemistry was compared.Results:FISH detected MYB/NFIB gene fusion in 41.7% (20/48) of the ACC. Its positive rate was inversely correlated with higher pathological grades ( P=0.036). The higher histological grade was linked to worse progression-free survival ( P=0.024), whereas there was no correlation between the status of gene fusion detected by FISH and progression-free survival ( P=0.536). FISH didnot detect MYB/NFIB gene fusion in 15 non-ACC salivary gland tumors The specificity of diagnosing ACC is 100% for both FISH detection of gene fusion and immunohistochemical detection of MYB expression. However, the sensitivity for both methods was only about 41.7%, respectively. By combining FISH and MYB immunohistochemistry, the sensitivity for diagnosing ACC was increased to 66.7%. Conclusions:MYB/NFIB gene fusion has a lower detection rate in grade Ⅲ ACC and high-grade transformation ACC. Meanwhile gene fusion status is not correlated with prognosis. The sensitivity for diagnosing ACC can be improved by combining FISH and MYB immunohistochemistry.

Objective To observe the effect of oxycodone hydrochloride combined with parecoxib sodium preemptive analgesia on postoperative pain in patients undergoing gynecologic laparoscopic surgery.Methods The clinical data of patients who underwent gynecological laparoscopic surgery at the General Hospital of Huainan Oriental Hospital Group from July 2021 to February 2023 were retrospectively analyzed and the patients were divided into a control group(parecoxib sodium)and a combined group(oxycodone hydrochloride combined with parecoxib sodium)according to the different preemptive analgesic regimens.The observational indexes of this study included opioid consumption within 24 h postoperatively,visual analog scale(VAS)scores at 0,2,6,12 and 24 h postoperatively,the number of effective presses of the patient controlled analgesiac(PCA),the time of the first press of the PCA,the number of remedial analgesia,the satisfaction of analgesia,and the occurrence of postoperative adverse reactions.Results A total of 80 patients were included in the study,with 39 in the control group and 41 in the combined group.The time of the first press of the analgesic pump was significantly longer in the combined group than in the control group(P＜0.05),while the number of effective presses and sufentanil consumption were significantly lower in the combined group than in the control group(P＜0.05).The difference in the number of remedial analgesia between the two groups was not statistically significant(P＞0.05).The VAS scores at 0 h,2 h and 6 h postoperatively in the combined group were significantly lower than those in the control group(P＜0.05),and the differences between the VAS scores at 12 h and 24 h postoperatively were not statistically significant(P＞0.05).The analgesic satisfaction score of patients in the combined group was significantly higher than that of the control group(P＜0.05),and the difference in the incidence of adverse reactions was not statistically significant(P＞0.05).Conclusion The preemptive analgesia regimen of oxycodone hydrochloride combined with parecoxib sodium significantly reduced the consumption of opioid drugs in patients after gynecological laparoscopic surgery,alleviated postoperative pain,and improved patient satisfaction.

By reviewing the relevant literature of ancient herbal works and modern codices， this paper sorted out the historical evolution and developmental venation of processing of Notoginseng Radix et Rhizoma. On this basis， the modern research of processed products of Notoginseng Radix et Rhizoma was used as the breakthrough point to analyze the literature in terms of processing technology， chemical composition changes and changes in pharmacological effects before and after processing. According to the research status of processing of Notoginseng Radix et Rhizoma， some existing problems were analyzed in this paper， such as not many ancient processing methods used in modern time， lack of standardized research on processing technology. And saponins， polysaccharides， amino acids， flavonoids and other chemical components in Notoginseng Radix et Rhizoma may change to different degrees before and after processing， which was the main reason for the difference of efficacy before and after processing. However， the current research on the pharmacological effects of Notoginseng Radix et Rhizoma mainly focuses on raw products， resulting in a lack of in-depth research on the transformation mechanism of Notoginseng Radix et Rhizoma in processing difference， and the scientific connotation of "Shengxiao Shubu" has not been clearly elaborated， which is not conducive to the standardized clinical use of drugs. Therefore， it is necessary to further analyze the material basis of Notoginseng Radix et Rhizoma and its processed products， and to explore the change rule of chemical components before and after processing and its correlation with pharmacodynamic activity， so as to clarify the processing mechanism for providing scientific basis for its standardized processing， quality control and clinical rational use.

Objective:To investigate the role and mechanism of microRNA-499 (miR-499) regulating α-myosin heavy chain (α-MHC) and β-myosin heavy chain (β-MHC) gene axis in septic myocardial dysfunction (SMD) and its significance.Methods:Sixty healthy adult male Sprague-Dawley (SD) rats were divided into phosphate buffered saline (PBS) control group (PBS group), lipopolysaccharide (LPS) induced SMD model group (LPS group), miR-499 agonist pretreatment group (agomir+LPS group), and miR-499 inhibitor pretreatment group (antagomir+LPS group) by random number table, with 15 rats in each group. SMD rat model was reproduced by intraperitoneal injection of LPS 10 mg/kg. The PBS group was intraperitoneally injected with the same amount of PBS. The two pretreatment groups were injected with agomir 30 mg/kg or antagomir 80 mg/kg through the caudal vein for 3 days, once a day. PBS group and LPS group were not pretreated. Echocardiography was detected 5 hours after LPS injection, and relevant indexes were recorded. The expression of miR-499 in plasma and myocardial tissue was detected by real-time quantitative polymerase chain reaction (qPCR). Western blotting was used to detect the protein expressions of α-MHC and β-MHC in myocardial tissue. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), a marker of heart failure, was measured by electrochemiluminescence.Results:Compared with the PBS group, the rats in LPS group were depressed. Additionally, LPS down-regulated the level of miR-499 in plasma and myocardial tissue, decreased α-MHC expression in myocardial tissue and up-regulated the expression of β-MHC. Echocardiography showed that left ventricular ejection fraction (LVEF), left ventricle fractional shortening (LVFS), cardiac output (CO), stroke volume (SV) and heart rate (HR) decreased by 49.1%, 59.2%, 48.8%, 39.4% and 15.9%, respectively, and the level of plasma NT-proBNP increased significantly in LPS group, indicating that LPS could induce cardiac dysfunction in rats. Compared with the LPS group, after pretreatment with agomir to overexpress the miR-499, LVEF and LVFS were significantly increased [LVEF: 0.662±0.020 vs. 0.323±0.024, LVFS: (36.16±1.43)% vs. (20.20±1.32)%, both P < 0.01], which suggested that the cardiac function of rats was improved in agomir+LPS group. At the same time, pretreatment with agomir significantly down-regulated the β-MHC protein expression (β-MHC/GAPDH: 0.74±0.04 vs. 2.97±0.34, P < 0.01), significantly up-regulated α-MHC protein expression (α-MHC/GAPDH: 1.59±0.05 vs. 0.74±0.14, P < 0.01), and significantly decreased the plasma NT-proBNP level (ng/L: 114.49±6.85 vs. 334.13±4.36, P < 0.01). After pretreatment with antagomir to inhibit the expression of miR-499, echocardiography showed that LVEF and LVFS were significantly lower than those in the LPS group [LVEF: 0.297±0.021 vs. 0.323±0.024, LVFS: (19.38±1.52)% vs. (21.20±1.32)%, both P < 0.01], which suggested that the cardiac function of rats was significantly inhibited. At the same time, pretreatment with antagomir significantly down-regulated α-MHC protein expression in myocardial tissue (α-MHC/GAPDH: 0.63±0.03 vs. 0.74±0.14, P < 0.01), significantly up-regulated β-MHC protein expression (β-MHC/GAPDH: 3.03±0.47 vs. 2.97±0.34, P < 0.01), and significantly increased the level of plasma NT-proBNP (ng/L: 373.91±4.23 vs. 334.13±4.36, P < 0.05). Conclusions:miR-499 could regulate the expression of α-MHC and β-MHC which improved cardiac dysfunction caused by sepsis. Targeted regulation of miR-499 expression may be an effective way to treat SMD.

Objective To investigate the predictive value of depth of invasion (DOI) of tongue squamous cell carcinoma (TSCC) for cervical lymph node metastasis and prognosis. Methods We retrospectively analyzed the clinical and pathological data of 73 patients with T_1/2 TSCC. ROC curve was used to determine the optimal cut-off value of DOI for predicting cervical lymph node metastasis, and logistic regression analysis was performed to analyze the related factors affecting cervical lymph node metastasis of TSCC. Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results Among 73 patients, 18 patients were with lymph node metastasis and 55 patients were without lymph node metastasis. The median DOI with and without lymph node metastasis were 8.00 and 5.00 mm, respectively (P=0.003). The optimal cut-off value for DOI was 6.15 mm, with AUC 0.75 (95%CI: 64.1%~87.1%, P=0.001), sensitivity 77.8% and specificity 63.6%. DOI and pathological differentiation were independent prognostic factors for cervical lymph node metastasis in multivariate analysis. DOI, nerve invasion and pathological differentiation were independent prognostic factors of survival in Cox regression analysis. Conclusion DOI of TSCC patients has important predictive value for both cervical lymph node metastasis and prognosis. Neck lymph node dissection is recommended for patients with DOI > 6.15 mm to improve survival rate and reduce recurrence rate.

Objective:To observe the clinical characteristics and reproductive outcome of patients with globozoospermia syndrome (also called round-headed spermatozoa).Methods:The data of 5 patients with round-headed spermatozoa and 20 healthy men in the reproductive center of Shanxi Maternal and Child Hospital and Shanxi People′s Hospital from July 2016 to March 2020 were collected. Among them, the wife was healthy. The peripheral blood chromosome, AZF gene, semen routine and morphology, sex hormone series were detected for the man, and the outcome of intracytoplasmic sperm injection (ICSI) was observed for the patients.Results:The average length of infertility in 5 patients with round-headed sperm was (4.4±1.8)years, and the round-headed sperm rate of 5 patients were all over 95% (including 1 case with round-headed sperm rate of 99%, 3 cases with round-headed sperm rate of 98%, and 1 case with round-headed sperm rate of 96%). The chromosome, AZF gene of 5 patients were normal. The sperm motility [progressive motility(PR) rate+ non progressive motility (NP) rate] of patients with globozoospermia syndrome was significantly lower than that of the healthy control group ( P<0.05). There was no significant difference in sex hormone, sperm count, sperm density, PR(%) and sperm DNA fragmentation rate compared with normal fertility group ( P>0.05). All the 5 patients were treated by assisted reproductive technology with ICSI. Two patients were pregnant, including one patient with abortion and one patient with singleton. Conclusions:There are no other abnormal phenotypes in patients with round-headed spermatozoa except for the low morphology and motility of round headed spermatozoa. Assisted reproductive technology may be an effective way to assist pregnancy.

Objective:To develope an automatic volumetric modulated arc therapy (VMAT) planning for rectal cancer based on a dose-prediction model for organs at risk(OARs) and an iterative optimization algorithm for objective parameter optimization.Methods:Totally 165 VMAT plans of rectal cancer patients treated in Peking University Cancer Hospital & Institute from June 2018 to January 2021 were selected to establish automatic VMAT planning. Among them, 145 cases were used for training the deep-learning model and 20 for evaluating the feasibility of the model by comparing the automatic planning with manual plans. The deep learning model was used to predict the essential dose-volume histogram (DVH) index as initial objective parameters(IOPs) and the iterative optimization algorithm can automatically modify the objective parameters according to the result of protocol-based automatic iterative optimization(PBAIO). With the predicted IOPs, the automatic planning model based on the iterative optimization algorithm was achieved using a program mable interface.Results:The IOPs of OARs of 20 cases were effectively predicted using the deep learning model, with no significantly statistical difference in the conformity index(CI) for planning target volume(PTV)and planning gross tumor volume(PGTV)between automatic and manual plans( P>0.05). The homogeneity index (HI) of PGTV in automatic and manual plans was 0.06 and 0.05, respectively( t=-6.92, P< 0.05). Compared with manual plans, the automatic plans significantly decreased the V30 for urinary bladder by 2.7% and decreased the V20 for femoral head sand auxiliary structure(avoidance)by 8.37% and 15.95%, respectively ( t=5.65, 11.24, P< 0.05). Meanwhile, the average doses to bladder, femoral heads, and avoidance decreased by 1.91, 4.01, and 3.88 Gy, respectively( t=9.29, 2.80, 10.23, P< 0.05) using the automatic plans. The time of automatic VMAT planning was (71.49±25.48)min in 20 cases. Conclusions:The proposed automatic planning based on dose prediction and an iterative optimization algorithm is feasible and has great potential for sparing OARs and improving the utilization rate of clinical resources.

Objective:To compare and analyze the image quality, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of T 1WI_Star_VIBE_FS sequence in MRI simulation of neck tumors with different scanning methods, aiming to determine the optimal scanning method. Methods:A retrospective analysis of 78 patients receiving MRI contrast scan was performed. All patients were randomly divided into three groups according to three different scanning methods including bolus mode (group A, n=23), segmentation splicing mode (group B, n=18) and the combination mode (group C, n=37). The image quality, SNR and CNR of the anterior soft tissues of neck were statistically compared. Results:A higher image quality score was obtained in group C. The mean SNR and CNR in three groups were calculated as 214.70±148.78, 91.95±59.26, 307.61±127.80, and 208.74±148.27, 85.79±59.50, 301.58±127.48, respectively. The image quality score, SNR and CNR in group C were significantly better compared with those in group A and B (all P<0.01). Conclusion:Combination of bolus and segmentation splicing modes is a recommended approach in MRI simulation during radiotherapy of neck tumors.