OBJECTIVE To systematically evaluate the efficacy and safety of different chemotherapy combination regimens for first-line treatment of metastatic colorectal cancer （mCRC）. METHODS PubMed， Cochrane Library， Embase and Web of Science were electronically searched to collect randomized controlled clinical trial （RCT） on first-line treatment for mCRC from January 1， 2000 to February 16， 2025. Two reviewers independently screened literature， extracted data and assessed the risk of bias of the included studies. Network meta-analysis was performed by using R4.4.3 and Stata 17.0 software. RESULTS A total of 28 RCTs， involving 16 intervention measures， were included. In terms of prolonging progression-free survival （PFS） and overall survival （OS）， FOLFOX （5-fluorouracil+oxaliplatin+calcium folinate regimen）+cetuximab had the highest probability of ranking first. In terms of improving objective response rate （ORR）， FOLFOXIRI （5-fluorouracil+oxaliplatin+irinotecan+calcium folinate regimen）+ bevacizumab and FOLFOX+bevacizumab+nivolumab had the highest probability of ranking first； in terms of the incidence of grade 3 or higher adverse reactions， FOLFOXIRI+panitumumab had the highest probability of ranking first； in subgroup analysis of KRAS wild-type patients， FOLFIRI （5-fluorouracil+irinotecan+calcium folinate regimen）+panitumumab and FOLFIRI+bevacizumab had the highest probability of ranking first in terms of prolonging PFS and OS， respectively； in terms of ORR， FOLFOXIRI+ cetuximab had the highest probability of ranking first. CONCLUSIONS In first-line treatment for mCRC， FOLFOX combined with targeted therapy has advantages in terms of efficacy and safety. However， individualized treatment strategies should be formulated based on the KRAS gene status and tumor location of patients.

【Objective】 To explore the risk factors for the production of anti-HLA antibodies in patients with hematological diseases before hematopoietic stemcell transplantation. 【Methods】 The results and clinical data of 1 008 patients with hematological diseases in our hospital who underwent anti-HLA antibody testing were collected by using Luminex technology platform before transplantation from 2016 to 2018 for statistical analysis. 【Results】 The total positive rate of anti-HLA antibodies in 1 008 patients was 24.08%. Multivariate analysis showed that independent risk factors associated with the production of anti-HLA antibodies included age≥30 years old(P=0.046, OR1.467, 95%CI1.007-2.136), time from disease diagnosis to antibody testing≥41 days(P=0.000, OR1.830, 95%CI1.306-2.565), initial platelet count<20×10⁹/L(P=0.020, OR1.543, 95%CI1.072-2.220), prior pregnancy(P=0.000, OR5.187, 95%CI3.689-7.293), transfusions before admission(P=0.001, OR1.762, 95%CI1.257-2.470)and total platelet transfusion volumes after admission≥30 U(P=0.000, OR2.352, 95%CI1.638-3.376). Age ≥30 years old(P=0.023, OR=1.839, 95%CI1.088-3.108)and prior pregnancy(P=0.042, OR=5.258, 95%CI1.062-26.038)are associated with the production of anti-HLA class Ⅰ and class Ⅱ antibodies, respectively. The time from disease diagnosis to antibody testing≥41 days(P=0.000, OR=2.873, 95%CI1.612-5.119), initial platelet count<20×10⁹/L(P=0.008, OR=2.164, 95%CI1.225-3.822), prior pregnancy(P=0.002, OR=6.734, 95%CI1.993-22.751), transfusions before admission(P=0.001, OR=2.746, 95%CI1.531-4.925)and total platelet transfusion volumes after admission>30 U(P=0.006, OR=3.459, 95%CI1.416-8.451)are associated with the production of anti-HLA class Ⅰ and Ⅱ antibodies. 【Conclusion】 Older age, longer course of disease, lower PLT count, history of pregnancy and blood transfusion, and higher total amount of PLT transfusion are risk factors which affect the production of anti-HLA antibodies.Therefore, it is advisable to test for anti-HLA antibodies according to the situation before transplantation, which is of great value in guiding donor selection, monitoring antibody changes and improving transplant prognosis.

BACKGROUND:Unicompartmental knee arthroplasty can effectively treat severe unilateral knee osteoarthritis.It has been found that posterior tibial cortical fracture is prone to occur after unicompartmental knee arthroplasty.The fracture begins at the keel groove of tibial osteotomy.The tibial prosthesis riser length affects the biomechanical results of the knee joint after unicompartmental knee arthroplasty. OBJECTIVE:To investigate the effect of tibial prosthesis riser length on knee biomechanics in unicompartmental knee arthroplasty,and to find out the relationship between prosthesis riser length and anterior and posterior tibial diameters of patients. METHODS:Computed tomography image data and commonly used unicompartmental prostheses were selected from a 37-year-old healthy female with no history of knee disease.A natural knee joint model was established and a unicompartmental prosthesis model was built.Eight different lengths of tibial prosthesis risers were established,with a minimum length of 31 mm and a maximum length of 34.5 mm in 0.5 mm increments,for comparison with the commonly used hospital prosthesis riser length of 33.2 mm.The material of the femoral component and tibial disc was cobalt-chromium-molybdenum alloy,and the tibial spacer was ultra-high molecular weight polyethylene.The biomechanical changes of the knee joint were observed using finite element analysis software loaded with 1000 N over the femur. RESULTS AND CONCLUSION:(1)The tibial stress was minimal at a tibial prosthesis riser length of 33 mm;the anterior cruciate ligament stress was minimal;the lateral meniscus stress was minimal,and the femoral prosthesis stress was minimal.The remaining components were less stressful.(2)The subject's medial tibial plateau anterior-posterior diameter length was 53 mm,and by calculating the ratio,the optimal ratio of tibial prosthesis riser length to anterior-posterior tibial diameter should be about 62%.If it is lower than this value,aseptic loosening of the prosthesis may occur,and if it is higher than this value,fracture of the bone cortex at the anterior-posterior end of the tibia may occur.

The traditional Chinese medicine （TCM） in pediatric care has a long history，proven efficacy，and distinctive characteristics.The China Association of Chinese Medicine has organized a series of youth salons to discuss the clinical advantages of treating diseases.Experts at this seminar proposed that the superior disease categories in pediatric TCM are significant for showcasing the unique strengths and advantages of TCM in the treatment of pediatric diseases，enhancing diagnostic and treatment levels，inheriting TCM knowledge，promoting the integration of TCM and Western medicine，and meeting patients' needs.The strengths of pediatric TCM are summed up as "having what others do not，excelling at what others have，being special in what others excel at，and ensuring safety in what others specialize in." The scope of superiority in pediatric TCM covers multiple systems，including respiratory，digestive，endocrine，psychological，and dermatological systems.This article summarized the advantages of TCM in treating 13 diseases discussed in the salon，such as upper respiratory tract infections，coughs，pneumonia，allergic rhinitis，bronchial asthma，atopic dermatitis，functional dyspepsia，functional constipation，enuresis，marginal short stature，simple obesity，attention deficit hyperactivity disorder，and tic disorders.The overall advantages were reflected in three aspects：First，the holistic concept and treatment based on syndrome differentiation in TCM highlight the advantage of treating the root causes of diseases，making the treatment methodical and precise.Second，most traditional Chinese herbs are natural and have strong safety profiles.Third，TCM treatment methods are abundant，especially the external treatment methods，which are widely used in pediatrics，highly accepted by parents，and have definite efficacy，as well as good safety and compliance.

AIM To establish an HPLC method for the simultaneous content determination of gallic acid,protocatechuic acid,morroniside,loganin,sweroside,paeoniflorin,hypericin,astragalin,salvianolic acid B,salvianolic acid A,epimedin C and icariin in Bushen Huoxue Sanjie Capsules.METHODS The analysis was performed on a 30℃thermostatic Agilent 5 TC-C18 column(250 mm×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1%phosphoric acid flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelength was set at 240 nm.RESULTS Twelve constituents showed good linear relationships within their own ranges(r≥0.999 8),whose average recoveries were 97.11%-101.14%with the RSDs of 0.60%-2.65%.CONCLUSION This simple,accurate and reproducible method can be used for the quality control of Bushen Huoxue Sanjie Capsules.

Objective To explore the effects of low-dose esketamine on the median effective dose(ED50)of ciprofol for sedation in elderly patients undergoing ultrasound-guided transperineal prostate biopsy.Methods Forty-nine elderly male patients,aged 65-75 years,BMI 18.5-30.0 kg/m2,ASA physical stutas Ⅰ-Ⅲ,who underwent ultrasound-guided transperineal prostate biopsy,were randomly as-signed into the esketamine-ciprofol group(group E,n=23)and the ciprofol group(group C,n=26).After intravenous administration of sufentanil 0.1 μg/kg,patients in group E received esketamine 0.2 mg/kg,while patients in group C received the same volume of normal saline.The up-and-down sequential allocation method was used to calculate the effective dose of ciprofol.The initial dose of ciprofol was 0.2 mg/kg in group E and 0.3 mg/kg in group C,and the dose gradient was 0.05 mg/kg for both groups.If there was no body movement during the first puncture of prostate after the loss of eyelash reflex,the ciprofol dose in the next patient was reduced by 0.05 mg/kg.Otherwise,the ciprofol dose in the next patient was in-creased by 0.05 mg/kg.The study was completed until 7 inflection points alternating between non-body movement and body movement achieved.The total amount of ciprofol,surgical time,recovery time,stay in recovery room,hypotension,bradycardia,respiratory depression,injection pain,nausea and vomiting,and adverse reaction of the mental system were recorded.The Probit method was used to calculate the ED50 and 95%effective dose(ED95)with 95%confidence interval(CI)of ciprofol for inhibition of body movement.Results Compared with group C,the total amount of ciprofol in group E was significantly reduced(P＜0.05).There were no significant differences between the two groups in surgical time,recovery time,stay in recovery room,and adverse events.The ED50 of ciprofol in group E was 0.22 mg/kg(95%CI 0.19-0.26 mg/kg),and the ED50 in group C was 0.38 mg/kg(95%CI 0.31-0.46 mg/kg).Compared with group C,the ED50 in group E was significantly reduced(P＜0.05).The ED95 of ciprofol in group E was 0.28 mg/kg(95%CI 0.25-0.49 mg/kg),and the ED95 in group C was 0.51 mg/kg(95%CI 0.44-1.25 mg/kg).Compared with group C,the ED95 in group E was significantly reduced(P＜0.05).Conclusion The ED50 of ciprofol for inhibition of body movement in elderly patients undergoing ultrasound-guided transperi-neal prostate biopsy was 0.38 mg/kg,which was reduced to 0.22 mg/kg by using lose-dose esketamine 0.2 mg/kg as an adjuvant.

Objective To analyze the expression of N-MYC and N-MYC downstream regulated gene-1(NDRG1)in gastric cancer tissues,and to assess their effects on biological characteristics of gastric cancer cells.Methods Paired of gastric cancer tissues and adjacent normal tissues resected from 82 cases of patholog-ically confirmed gastric cancer who underwent surgical treatment in the hospital from January 2021 to May 2023 were collected.Gastric cancer tissues and adjacent normal tissues of 82 patients who were surgically re-sected and pathologically diagnosed with gastric cancer in the hospital from January 2021 to May 2023 were collected.Real-time quantitative PCR(qPCR)was used to detect the relative mRNA expression levels of N-MYC and NDRG1,and clinical data of the patients were collected.The correlation between the mRNA expres-sion of N-MYC and NDRG1 and clinicopathological features of the patients was discussed.NCI-N87 cells in logarithmic growth phase were selected and cultured in vitro.N-MYC interference plasmid(si-N-MYC)and its negative control(si-NC)was transfected into NCI-N87 cells,respectively,which were recorded as si-NC group and si-N-MYC group.Moreover,si-N-MYC was co-transfected into NCI-N87 cells with anti-NC and an-ti-NDRG1,respectively,and denoted as si-N-MYC+anti-NC group and si-N-MYC+anti-NDRG1 group.CCK-8 assay was used to detect cell proliferation activity,Transwell assay was used to detect cell invasion ability,and Western blotting assay was used to detect N-MYC and NDRG1 protein expression in cells.Results The relative expression of N-MYC mRNA in gastric cancer tissues was higher than that in paracancer tissues(P＜0.05),and the relative expression of NDRG1 mRNA was lower than that in paracancer tissues(P＜0.05).There were significant differences in the expression of N-MYC and NDRG1 mRNA in patients with different TNM stages,lymph node metastasis and distant metastasis(P＜0.05).Compared with the si-NC group,the cell proliferation and invasion ability of the si-N-MYC group were decreased(P＜0.05),and the expression of NDRG1 protein was down-regulated(P＜0.05).Compared with si-N-MYC+anti-NC group,cell proliferation and invasion ability of si-N-MYC+anti-NDRG1 group were increased(P＜0.05).N-MYC could target and regulate NDRG1,and knocking down NDRG1 could reverse the biological effects of N-MYC on gastric cells.Conclusion In gastric cancer tissue,N-MYC mRNA expression is upregulated and NDRG1 mRNA expression is downregulated,both of which play important roles in the regulation of malignant biological behaviors such as proliferation and invasion of gastric cancer cells.

Objective To investigate the diagnosis value of contrast-enhanced ultrasound (CEUS) in the differentiation of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) of the liver with ≤3 cm of maximum diameter. Methods The image characteristics in 48 lesions of HCC with maximum diameter≤3 cm and 48 lesions of FNH with maximum diameter≤3 cm confirmed by pathology were retrospectively analyzed. The phase changes, enhancement patterns and enhancement characteristics of the lesions in the two groups were compared. Results All lesions in the two groups showed high-echo in the arterial phase. The contrast arrival time in HCC group and FNH group was 17(15, 19) s and 15(12, 18.75) s (P＝0.017); the peak time in the two groups was 21(17, 25) s and 22(19, 26) s (P＞0.05). The main enhancement patterns of HCC group and FNH group in arterial phase were homogeneous enhancement and centrifugal enhancement, respectively. All HCC lesions showed homogeneous enhancement, which was significantly higher than FNH (2.08%, P＜0.05); 97.91% of FHN lesions showed centrifugal enhancement, which was higher that of HCC lesions (0, P＜0.05). During the CEUS process, 87.5% of HCC lesions showed “rapid fill-in and rapid wash-out”, which was significantly higher than that of FNH lesions（8.33%，P＜0.05）; 91.67% of FNH lesions showed “rapid fill-in” and “synchronous/slow wash-out” which was significantly higher than that of HCC lesions （12.50%，P＜0.05）. Conclusion CEUS is helpful in the differential diagnosis of FNH and HCC with maximum diameter≤3 cm．

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective To study the effects of Chrysanthemum Flos on blood pressure of spontaneously hypertensive rats(SHR)and evaluate its antioxidant activity in vitro and in vivo.Methods SHR were randomly divided into model,control and experimental-L,-H groups with 10 rats per group,and 10 WKY rats as blank group.Experimental-H,-L groups were given 2.10 and 0.525 g·kg-1 Chrysanthemum Flos extract by gavage;control group received 5.25 mg·kg-1 losartan by gavage;blank and model groups were given the same volume of 0.9％NaCl solution by gavage.Rats in each group were gavaged once a day for 8 weeks.After 8 weeks of continuous intragastric administration,the systolic blood pressure(SBP)and diastolic blood pressure(DBP)were observed.The contents of catalase(CAT),superoxide dismutase(SOD),glutathione peroxidase(GSH)and malondialdehyde(MDA)in serum were measured with kit colorimetry method.The in vitro free radical scavenging rates of Chrysanthemum Flos extract were detected by 1,1-diphenyl-2-picrylhydrazyl(DPPH)and 2,2'-amino-di(2-ethyl-benzothiazoline sulphonic acid-6)ammonium salt(ABTS)methods.Results The SBP of blank,model,control and experimental-H,-L groups were(132.00±2.45),(204.00±4.55),(171.00±2.16),(181.00±3.74)and(184.67±4.78)mmHg;the DBP were(73.33±4.03),(175.67±3.40),(120.33±0.94),(125.33±2.87)and(125.67±2.36)mmHg;the contents of serum CAT were(9.24±3.99),(8.40±2.98),(9.24±2.42),(8.59±2.70)and(8.49±1.47)U·mL-1;the contents of serum SOD were(122.40±12.30),(75.30±28.37),(125.39±31.35),(110.92±26.14)and(103.37±22.31)U·mL-1;the contents of serum GSH were(117.93±10.18),(78.29±23.68),(118.57±26.08),(109.89±20.52)and(98.73±14.71)U·mL-1;the contents of serum MDA were(8.36±2.08),(8.45±3.38),(8.22±3.04),(7.09±3.21)and(7.24±3.32)nmol·L 1,respectively.Compared with model group,the differences of above indicators in control group and experimental-H,-L groups were statistically significant(P＜0.05,P＜0.01).Chrysanthemum Flos extract showed certain free radical scavenging ability in vitro.The highest scavenging rates of DPPH and ABTS were 90.29％and 92.67％,respectively.Conclusion Chrysanthemum Flos extract had good antihypertensive activity.The antioxidation ability might be its antihypertensive mechanisms.