Objective:To evaluate the effect of hyperthermia on radiation pneumonitis (RP) in elderly patients with esophageal cancer undergoing intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 177 elderly esophageal cancer patients (aged ≥60 years) receiving IMRT in the First Affiliated Hospital of Soochow University and Yixing Cancer Hospital from August 1, 2017 to February 6, 2023 were retrospectively analyzed. Patients were divided into the hyperthermia and non-hyperthermia groups based on whether they received hyperthermia treatment. Patients in two groups received IMRT with 6 MV X-rays. Patients in the hyperthermia group underwent high-frequency hyperthermia within 1 h before radiation using the external thermotherapy device HG-2000Ⅲ (heating temperature: 41-43 ℃ for 40 min, twice a week). After adjusting for confounding factors between two groups using propensity score matching (PSM), the short-term effective rates between two groups were compared using Chi-square test. Univariate analysis and logistic multivariate analysis were employed to compare the incidence of RP between two groups. Results:After applying PSM, 42 pairs were successfully matched, and the baseline data and radiotherapy parameters showed no statistically significant differences between two groups (all P>0.05). The objective response rate (ORR) in the hyperthermia group was significantly higher than that in the non-hyperthermia group (83.3% vs. 64.3%, P=0.047). Univariate analysis revealed that the incidence of RP and symptomatic RP (≥ grade 2) in the hyperthermia group was significantly lower than that in the non-hyperthermia group (61.9% vs. 85.7%, P=0.013; 21.4% vs. 47.6%, P=0.012). Logistic multivariate analysis indicated that hyperthermia was an independent protective factor for symptomatic RP ( P=0.011). Conclusions:The incidence and severity of RP in elderly esophageal cancer patients receiving IMRT can be reduced by hyperthermia. Hyperthermia, as a clinically beneficial green treatment, improves efficacy and reduces toxicity for patients with esophageal cancer.

[摘 要] 目的：探讨免疫检查点抑制剂（ICI）治疗非小细胞肺癌（NSCLC）患者发生免疫检查点抑制剂相关性肺炎（CIP）的发生情况和免疫治疗疗效的关系，分析接受ICI治疗的NSCLC患者的预后相关因素。方法：回顾性分析2020年3月至2023年3月在新疆医科大学附属肿瘤医院接受ICI治疗145例NSCLC患者的临床资料，将患者分为CIP组和非CIP组，随后将发生CIP的患者分为轻度（1、2级）CIP和重度（3、4级）CIP两个亚组，通过Kaplan-Meier法比较生存曲线，分析CIP的发生及严重程度对于患者PFS及OS的影响。通过单因素及多因素COX风险比例回归模型分析与PFS和OS相关的预后因素。结果：145例患者中有26例患者出现CIP，发生率为17.93％，重度CIP发生率为3.45%。CIP组患者PFS明显长于非CIP组患者（12.3 vs 7.6个月，P<0.05），CIP组与非CIP组的OS比较差异无统计学意义（16.2 vs 15.8个月，P>0.05)。亚组分析显示，轻度CIP和重度CIP相比，PFS（12.2 vs 12.9个月）及OS（16.1 vs 17.8个月）均无统计学意义（均P>0.05）。多因素COX回归分析显示，CIP[HR=0.55，95%CI（0.33, 0.90），P=0.02]、免疫疗程>6个[HR=0.51，95%CI（0.31, 0.85），P=0.01]是影响患者PFS的有利预后因素，免疫疗程>6个[HR=0.4，95%CI（0.18, 0.88），P=0.02]是影响OS的有利预后因素。结论：CIP的发生率为17.93％，CIP的发生与PFS的延长密切相关。免疫疗程>6个是影响NSCLC患者PFS、OS的有利预后因素。

Objective:To discuss the effect of concentrated growth factor(CGF)on the performance of bone marrow mesenchymal stem cells(BMSCs)sheets,and to clarify the role of CGF-containing composite cell sheets(CS)in the bone defect repairment.Methods:In in vitro experiments,the BMSCs were isolated and cultured from two 3-week-old SD rats;Alizarin Red S and Oil Red O staining were used to identify the osteogenic and adipogenic capabilities of BMSCs;CGF liquid extracts(CGFe)was prepared from three 3-week-old SD rats.The cells were divided into control group,traditional CS(BMSC-CS)group,and CGF-containing composite CS(CGF/BMSC-CS)group.The morphology of the CS in two groups was observed by HE staining.Alizarin Red and alkaline phosphatase(ALP)staining were used to detect the osteogenic differentiation of the CS in various groups;cell scratch assay was used to detect the migration abilities of the cells in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the mRNA expression levels of ALP,collagen are type 1(COL-1),Runt-related transcription factor 2(RUNX2),and osteocalcin(OCN)in the cells in various groups.In in vivo experiments,15 SD rats were randomly divided into control group,BMSC-CS group,and CGF/BMSC-CS group;micro computed tomography(Micro-CT)was used to detect the bone formation parameters in skull defects of the rats in various groups;HE staining and Masson staining were used to observe the morphology of skull defect tissue of the rats in various groups.Results:The third-generation BMSCs were spindle-shaped,closely arranged,and grew in a vortex cluster.The Alizarin red staining results showed obvious calcium nodules,and the Oil red O staining showed red lipid droplets,confirming the cells'ability to undergo osteogenic and adipogenic differentiation.The CS were white and semi-transparent,with slightly curled edges.The peeled CS were irregularly curled and wrinkled.Compared with BMSC-CS group,the CS in CGF/BMSC-CS group were whiter,less transparent,significantly increased in thickness and extensibility,less prone to breakage,and had a certain degree of stickiness and plasticity.The HE staining results showed that compared with BMSC-CS group,the number of the cells of CS in CGF/BMSC-CS group was increased,with denser arrangement and more abundant extracellular matrix(ECM),which wrapped and connected the cells to form an integral sheet-like structure.The Alizarin red and ALP staining results showed that compared with control group,the ALP activity and mineralization uplift value of CS in BMSC-CS group were significantly increased(P<0.05);compared with control group and BMSC-CS group,the number of osteoblasts and red mineralized nodules in the CS in CGF/BMSC-CS group was significantly increased,with obvious deepening of the staining,increased positive area,and the ALP activity and mineralization uplift value were significantly increased(P<0.05).Compared with BMSC-CS group,the ALP activity and mineralization uplif value of the CS in CGF/DMSC-CS group were increased(P<0.05).The cell scratch assay results showed that after 24 of culture,compared with control group,the migration rates of the cells in BMSC-CS group and CGF/BMSC-CS group were significantly increased(P<0.05).Compared with BMSC-CS group,the migration rate of the cells in CGF/BMSC-CS group was significantly increased(P<0.01).After 48 h of culture,compared with control group,the migration rate of the cells in CGF/BMSC-CS group was significantly increased(P<0.05).The RT-qPCR results showed that compared with control group,the expression levels of COL-1 and OCN mRNA in the cells in BMSC-CS group were significantly increased(P<0.01),and the expression levels of ALP,COL-1,OCN,and RUNX2 mRNA in the cells in CGF/BMSC-CS group were significantly increased(P<0.01).Compared with BMSC-CS group,the expression levels of ALP,COL-1,and OCN mRNA in the cells in CGF/BMSC-CS group were significantly increased(P<0.01).The Micro-CT detection results showed that in control group,the boundary of the rat skull defect area was clear,with almost no new bone formation.In BMSC-CS group,a small amount of new bone formed only at the edge of the bone defect in skull of the rats,with a significant gap in the central area of the defect.In CGF/BMSC-CS group,new bone formed along the edge of the bone defect towards the central area in skull of the rats,repairing most of the bone defect.Compared with control group,the bone volume(BV)and trabecular number(Tb.N)of the rats in BMSC-CS group were significantly increased(P<0.05);the bone volume(BV),bone volume fraction[BV/tissue volume(TV)],trabecular thickness(Tb.Th),and trabecular number(Tb.N)in skull of the rats in CGF/BMSC-CS group,were significantly increased(P<0.05).Compared with BMSC-CS group,the BV,BV/TV,Tb.Th,and Tb.N in skull of the rats in CGF/BMSC-CS group were significantly increased(P<0.01).The HE and Masson staining observation showed that in control group,almost no new bone formed in the skull defect tissue of the rats,with only a large amount of collagen fibers connecting the two sides of the bone ends.In BMSC-CS group,a small amount of new bone formed only at the edge of the bone defect in skull tissue of the rats,with the central area of the defect containing dense collagen fibers connected to the newly formed bone at the defect edge.In CGF/BMSC-CS group,new bone tissue could be seen at the edge of the bone defect,and bone islands formed in the central area of the defect,surrounded by osteocytes and a large amount of collagen fibers.The Masson staining observation results showed that the cytoplasm and osteoid were red,and the collagen was blue.In CGF/BMSC-CS group,newly formed osteoid was observed in skull defect tissue of the rats,with the highest amount of new bone formation.Conclusion:CGF can promote the osteogenic differentiation and increase the richness of ECM in BMSCs sheets.CGF-containing composite CS can efficiently repair skull defects of the rats and serve as an ideal and safe material for promoting the bone regeneration.

Objective To explore the relationship between lactate dehydrogenase to albumin ratio(LAR)and short-term prognosis in patients with sepsis-associated acute kidney injury(AKI).Methods A retrospective analysis was conducted on 463 sepsis patients treated in the intensive care unit(ICU)of Beijing Shijitan Hospital,Capital Medical University,from January 2018 to June 2022.The patients were divided into two groups:a group with secondary AKI(AKI group)and the one without acute kidney injury(non-AKI group).Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ),Sequential Organ Failure Assessment(SOFA),and levels of procalcitonin(PCT),C-reactive protein(CRP),serum creatinine(SCr),lactate dehydrogenase(LDH),and albumin(ALB)were compared between the two groups.Multivariate logistic regression analysis was used to determine prognostic factors for sepsis-associated acute kidney injury,and Receiver Operating Characteristic(ROC)analysis was performed to assess the predictive value of APACHE Ⅱ score,SOFA score,PCT,SCr,and lactate dehydrogenase to albumin ratio(LAR)for short-term prognosis of sepsis-associated acute kidney injury.Results The 28-day mortality rate in the non-AKI group was lower than that in the AKI group,and the length of stay in ICU was shorter in the non-AKI group than in the AKI group(P<0.05).APACHE Ⅱ score,SOFA score,PCT,SCr and LAR were independent influencing factors for 28-days death in patients with sepsis-associated acute kidney injury.The ROC curve analysis showed that LAR level had a higher predictive value for short-term prognosis in patients with sepsis-associated AKI as compared with APACHE Ⅱ score,SOFA score,PCT,and SCr.Conclusions LAR is an independent risk factor for sepsis-associated AKI and is associated with 28-day mortality in patients.

Objective:To systematically evaluate the qualitative research on experience of fear of falling in the elderly, so as to provide theoretical basis for nursing practice.Methods:Qualitative researches on the fear of falling among the elderly were systematically searched in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine disc. The search period was from database establishment to November 5, 2023. The quality of literature was evaluated using the quality evaluation criteria for qualitative research of the Australia Joanna Briggs Institute Evidence-Based Health Care Center, and the results were integrated using the Meta-synthesis.Results:A total of 13 articles were included, 44 themes were extracted, categorized into 12 categories, and refined into four integrated results, namely perception of fear of falling, influencing factors of fear of falling, coping strategies in attitude and behavior, and multidimensional needs for rehabilitation nursing.Conclusions:Medical and nursing staff should pay attention to and understand the fear of falling among the elderly, evaluate their fear of falling from multiple dimensions and dynamically, provide personalized guidance based on coping behaviors, create support systems to alleviate their fear of falling and meet their multidimensional needs, so as to improve their quality of life.

Inflammation is the pathological basis of many diseases,which can infect locally or act on the whole body,and is closely related to the pathogenesis of many diseases.In recent years,in the background of more and more traditional anti-inflammatory drugs showing adverse reactions,scholars have been exploring the use of traditional Chinese medicine in the ascendant.As an herb in the Asteraceae(daisy)family,Artemisia dracunculus possesses low toxicity and a wide range of uses and can be applied to the regulation of metabolism,analgesia,antidepressant,antioxidant,immune regulation,antibacterial,anti-inflammatory,antiparasitic,and other treatment of a variety of diseases.In-depth studies have revealed that the therapeutic effects and potential of Artemisia dracunculus for a variety of diseases are closely related to its anti-inflammatory mechanism.This article will summarize the relevant literature in recent years and review the research progress of the mechanism of Artemisia dracunculus on the regulation of immune cells and inflammatory factors,as well as its mediation of inflammation-related signaling pathways,intending to provide theoretical references for future application of Artemisia dracunculus in clinical trials and treatments.

Objective: To investigate the expression pattern，underlying function and clinical significance of Guanylate-binding protein 1 ( GBP1) in pulmonary tuberculosis ( pTB) ． Methods: Immunohistochemical staining was applied to detect the expression of GBP1 in pTB specimensand control samples． Combined with Gene Expression Omnibus ( GEO) datasets ，including GSE83456 and GSE34608，receiver operating characteristic ( ROC) curve was depicted to assess the diagnostic value of GBP1 in pTB．Then，the correlation between GBP1 and related regulatory factors was analyzed by protein-protein interaction network ( PPI) ; Finally，the potential molecular mechanism of GBP1 in pTB was probed by Gene Set Enrichment Analysis( GSEA) . Results: Compared with the control group，GBP1 was significantly overexpressed in human pTB samples，including lung tissue and blood．The positive rate of GBP1 protein in pTB was 73. 9% . ROC curve analysis revealed that GBP1 might have important value in early diagnosis of pTB．GSEA analysis suggested that the hyper-expression of GBP1 was closely related to the host inflammatory response，IFN-γ/ α signaling pathway and TNF-α/ IL-6 signal transduction． Conclusion GBP1 is highly expressed in pTB tissues and is involved in the process of inflammatory response and host anti-tuberculosis infection ; GBP1 may be used as an early diagnostic marker or therapeutic target for pTB.

Objective : To investigate the effects of different occlusal veneer preparation designs and fiber posts on the fracture load and failure mode of endodontically treated maxillary premolars with pulp-piercing wedge-shaped defect． Methods : 60 maxillary first premolars were randomly divided into group A and group B after Root Canal Therapy (RCT) and severe defects(n = 30) ．Group A was filled with glass fiber post and resin core，and group B was filled with resin core only．Then the occlusal veneer( G2) ，buccal-occlusal veneer( G3) and buccal-proximal-occlusal veneer ( G4 ) were applied to the isolated teeth．The teeth filled with composite resin ( G1 ) and full crown ( G5) were set as negative and positive control respectively，with 6 samples in each group．The sample was subjected to 5 000 hot and cold cycles and 20 000 vertical compression load aging．Finally，all the samples were loaded with static load until the sample broke at the speed of 0．5mm / min．The fracture load and failure mode of each sample were recorded. Results : Both the fracture load in group A and B was G5 ＞G3 ＞G2 ＞G4 ＞G1，and the fracture load in G2，G3，G4，G5 was significantly higher than that in G1 (P＜0. 05) ，and there was no significant difference between group A and B (P＞0. 05) ．The fracture form of G3 was mostly unbonding of the repair body，which was conducive to re-repair． Conclusion Buccal ( occlusal) veneer is the most effective in repairing pulp-piercing wedge-shaped defects．The fiber post could not significantly enhance the fracture load of the pulp-piercing wedge- shaped defects teeth.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:Four cases with NLRP3-related autoinflammatory diseases were reported to summarize the clinical characteristics, genotype, and treatment responses of the disease, and to improve clinical pediatricians' understanding of the disease.Methods:A retrospective analysis was performed on 4 cases with NLRP3-related autoinflammatory diseases diagnosed in Children's Hospital of Anhui Province in 2016—2021, and the clinical features and treatment progress of NLRP3-related autoinflammatory diseases were retrospectively analyzed based on the clinical features, gene reports, and literature review.Results:① All 4 cases were male. Cases 1, 2, and 3 had the disease onset after birth, and case 4 had the disease onset 6 months after birth. All showed periodic fever, repeated urticaria-like rash, protruding forehead, and saddle nose. White blood cells count, erythrocyte sedimentation rate, and C-reactive protein were increased during the attack period, and those in the interval period were normal, and antibiotic treatment was ineffective. ② The genetic test of all these 4 children showed NLRP3 mutation. Children 1, 2, and 3 were heterozygous mutations, and their parents were wild-type. The mutation was located at chromosome Chr1: 247587658, exon c913 (exon3). G>A, the 305th aspartic acid (Asp) of the protein was changed to asparagine (Asn) in child 1. The mutation was located at the chromosomal Chr1: 247588072, the nucleic acid was changed to c1327(exon3)T>C, and the amino acid was changed to p.Y443H in cases 2 and 3. Somatic heterozygous mutation was found in case 4, and the child's parents were wild-type. In this case, the mutation was located at chromosomal Chr1: 247587658, exon3 G>A, and the 305th Asp of the protein was changed to Asn. ③Children in cases 1, 2, and 3 were treated with glucocorticoids and non-steroidal anti-inflammatory drugs at the initial stage, but the effects were limited. After receiving IL-1 antagonist treatment fever, skin rash, joint swelling and pain disappeared, and the inflammatory indexes were returned to normal. The child 4 received non-steroidal anti-inflammatory drugs and methotrexate, but he failed to respond to the treatment. Treatment with tocilizumab was not effective, however, fever, skin rash, or joint pain disappeared after treated with Khanna.Conclusion:①NLRP3-related autoinflammatory diseases can cause periodic fever, urticaria, joint involvement, and severe involvement of the central nervous system and organ amyloidosis. Which are early misdiagnosis is prone to systemic juvenile idiopathic arthritis. ②The disease was an inflammatory disease mediated by interleukin-1. At present, non-steroidal anti-inflammatory drug, glucocorticoid and chronic anti-rheumatic drugs have limited effects. IL-1 antagonists are effective and safe in the treatment of the disease.