Objective To evaluate the prognostic value of radiation-induced lymphocytopenia in the survival of patients with primary hepatocellular carcinoma receiving radiation therapy. Methods The clinical data of 98 patients with unresectable primary hepatocellular carcinoma who received radiotherapy were retrospectively analyzed. The minimum absolute lymphocyte count (min ALC) was graded in accordance with CTCAE V4.0. The optimal threshold of min ALC for prognosis was calculated by using the receiver operating characteristic curve, and the correlation of min ALC with clinical characteristics and dosimetry parameters was analyzed. The Kaplan-Meier method was employed to analyze the survival of patients with different levels of min ALC. Univariate and multivariate Cox proportional regression models were applied to analyze prognostic factors. Results The baseline and min ALC of 98 patients during radiotherapy were 1.52×10⁹/L and 0.45×10⁹/L, respectively(P<0.001). The optimal cut-off value of min ALC for the prediction of the one-year survival rate was 0.38×10⁹/L. GTV, the mean dose of the liver and spleen, the V5 and V10 of the liver and spleen, and the V15 of the spleen were correlated with min ALC, and the V5 of the liver was an independent predictor of min ALC. The overall survival of patients with high min ALC was higher than that of patients with low min ALC. Independent prognostic factors were min ALC≤0.38×10⁹/L (HR=0.515, P=0.024), min ALC≥grade 3 (HR=0.576, P=0.032), tumor thrombus in the portal/vena cava, Child-Pugh grade A, increase of ≥2 points in the Child-Pugh score after radiotherapy, and received more than two other therapies. Conclusion Min ALC≤0.38×10⁹/L and min ALC≥grade 3 have independent prognostic value in patients with unresectable hepatocellular carcinoma receiving radiotherapy.

【Objective】 To comprehensively explore the serological characteristics of anti-PP1P^k and potential therapeutic strategies for recurrent miscarriage in p-blood type pregnant women. 【Methods】 Neutralization with pigeon egg white and human plasma, disruption of IgM antibodies by 2-mercaptoethanol reagent, and complement adding were conducted. Anti-PP1P^k titers under different processing conditions, media and temperatures were determined, and neutralizing effect of human plasma on anti-PP1P^k and its sensitization complement ability were analyzed. 【Results】 The titers of anti-PP1P^k in saline and column agglutination were 4 and 8, respectively. Low temperature increased titers, while β-mercaptoethanol treatment significantly reduced them. Pigeon egg white partially neutralized anti-PP1P^k antibodies. Human plasma was also capable of reducing anti-PP1P^k titers with neutralization capability surpassing that of pigeon egg white, and there were individual differences in neutralization capability. 【Conclusion】 The anti-PP1P^k was a blend of antibodies encompassing both IgM and IgG types, exhibiting cold reactivity, and having the potential for complement activation. Human plasma emerges as an effective modulator for diminishing the efficacy of anti-PP1P^k. Plasma transfusion holds promise as a therapeutic avenue for addressing recurrent miscarriages in pregnant individuals with the p phenotype.

Objective This study aims to compare and analyze three types of generative artificial intelligence(GAI)and explore their application value and existing problems in the field of stomatology in the Chinese context.Methods A total of 36 questions were designed,covering all the professional areas of stomatology.The questions encompassed various aspects including medical records,professional knowledge,and translation and editing.These questions were submitted to ChatGPT4-turbo,Gemini(2024.2)and ERNIE Bot 4.0.After obtaining the answers,a blinded evaluation was conducted by three experienced oral medicine physicians using a four-point Likert scale.The value of GAI in vari-ous application scenarios was evaluated.Results Gemi-ni scored 45,ERNIE Bot scored 38,and ChatGPT scored 33 for clinical documentation and image production.For research assistance,Gemini achieved 45,ERNIE Bot had 39,and ChatGPT scored 35.Teaching assistance capabilities were rated at 54 for ERNIE Bot,50 for Gemini,and 48 for ChatGPT.In patient consultation and guidance,Gemini scored 78,ERNIE Bot scored 59,and ChatGPT scored 48.Over-all,the total scores were 218,190,and 164 for Gemini,ERNIE Bot,and ChatGPT,respectively.Among GAI applica-tions,the top scoring categories were article translation and polishing(26),patient-doctor communication documentation(23),and popular science content creation(23).The lowest scoring categories were literature search and reporting(13)and image generation(12).Conclusion In the Chinese context,the application value of GAI is the highest for Gemini,followed by ERNIE Bot and ChatGPT.GAI shows significant value in translation,patient-doctor communication,and popular science writing.However,its value in literature search,reporting,and image generation remains limited.

Radiotherapy is one of the main treatment methods for malignant tumors, which can cause the radiation damage to normal tissues. Radiation-induced skin injury (RISI) is one of the main adverse reactions caused by radiotherapy. The main clinical manifestations of RISI are dermatitis, ulcer, erosion and necrosis, which seriously affect the quality of life and treatment effect of tumor radiotherapy patients, and even affect the overall survival of patients. The pathological mechanism of RISI is still unclear. Some studies have shown that inflammation and oxidative stress are the main causes of RISI. RISI can be divided into acute and chronic RISI according to the different onset time, and different treatment strategies can be formulated according to the severity of the injury. In this article, clinical manifestations, classification, pathogenesis, prevention and treatment of RISI are comprehensively summarized.

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in postPCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

Periodontitis is a common chronic infectious oral disease, which is characterized by gingival inflammation,pocket formation, alveolar bone loss and tooth mobility. Psoriasis is a common chronic inflammatory skin disease, whose pathological features in skin lesions are excessive proliferation of epidermal cells, parakeratosis of the derma, and the infiltration of inflammatory cells. Both periodontitis and psoriasis are closely related to the interleukin(IL)-23/helper T cell 17(Th17)/IL-17 axis in their immunopathological mechanisms. The risk factors of psoriasis include smoking, vitamin D deficiency, obesity, emotional stress, etc, of which most factors are also common risk factors of periodontitis. The present article reviews the research advances in the interaction of the two diseases and their possible common mechanisms from three aspects, i.e. clinical study, IL-23/Th17/IL-17 pathway and common risk factors, which may be helpful to provide new ideas for clinical diagnosis and treatment.

Objective To explore the clinical characteristics of patients with autoimmune glial fibrillary acidic protein(GFAP) astrocytosis with central nervous system inflammation as the main manifestation.Methods Twenty-one patients with autoimmune GFAP astrocytosis with positive cerebrospinal fluid GFAP antibody were collected from January 2017 to April 2020.The clinical data of 14 patients with cerebrospinal fluid GFAP antibody positive were retrospectively analyzed.Results Among the 14 patients,4 were female and 10 were male.The age of onset was(42±16) years old.The main clinical manifestations of the patients were headache(13/14),fever(13/14),disturbance of consciousness(11/14),mental symptoms(10/14),epilepsy(4/10),defecation disorder(8/14),hypoxemia(6/14),limb paralysis(2/14),etc.MRI showed abnormal enhancement of intracranial meninges in 13 cases(13/14) and spinal cord involvement in 5 cases(5/14).Conclusion There are more males than females with autoimmune GFAP astrocytosis with cerebrospinal meningitis and other central system inflammation.MRI manifestations are complex.Intracranial and spinal cord can be involved at the same time.Intracranial lesions mainly involve meninges,which can be combined with cerebral cortex damage.In myelopathy,both the spinal cord and the spinal cord are involved,and the spinal cord membrane is mainly involved.

Objective To study the influence of conflict vessels of trigeminal neuralgia (TN) in microvascular decompression (MVD) efficacy.Methods The clinical data of 86 patients accepted MVD for TN,admitted to our hospital from July 2008 to August 2012,were retrospectively analyzed.According to the number of offending vessels under intranperative microscope,the patients were divided into single offending vessel group and multi-offending vessels group;the clinical features,distributions of offending vessels,imaging results and surgical findings of the two groups were compared.Results Forty-nine patients (57.0％) were enrolled to single offending vessel group,and 37 (43.0％) were enrolled to multi-offending vessels group;ratio of offside pain was higher than that of left side in both two groups.Conflict vessels in the single offending vessel group mainly were superior cerebellar artery (SCA,n=29,59.2％) and anterior inferior cerebellar artery (AICA,n=19,38.8％);conflict vessels in the multi-offending vessels group mainly were SCA+AICA (n=21,56.8％) and SCA+ petrosal vein (n=8,21.6％).Follow-up at 6 months after the operation showed an efficient outcome of 96.5％:the effective rate of single offending vessel group was 98.0％ while that of multi-offending vessels group was 94.6％ with significant difference(x2=0.003,P=0.958).No mortality or severe complications,such as hearing loss,cerebellar bleeding or cerebellar infarction,were recorded.Conclusions MVD is a safe and effective treatment for TN.MVD on multiple conflict vessels TN and that on single conflict vessel TN have approximate efficacy.

Objective To evaluate the clinical outcome associated with the core decompression in combination with the nano-hydroxyapatite/collagen composite rod combined with decalcified bone matrix in a consecutive series of patients with osteonecrosis of femoral head,especially the prevention of collapse of femoral head and its predisposing factors.Methods From August,2012 to May,2013,46 pationts (50 hips) who had undergone core decompression in combination with nano-hydroxyapatite/collagen composite rod insertion in corporated with decalcified bone matrix in our hospital were involved in this study.Postoperative care consisted of prophylactic intravenous antibiotic and anticoagulation therapy.Patients were instructed to be non-weight-bearing for 3 weeks,to partial weight-bear for the next 3 weeks,and to weight bear as tolerated thereafter.All patients were evaluated both clinically and radiographically.The primary clinical outcome of this study was functional improvement assessed with the Harris hip score.Serial radiograms of the pelvis were taken at 1,3,6,12 months post-operatively to analyze the process of osteonecrosis.Results All patients followed up for 12 months,no one suffer complications.The mean Harris score pre-operation was 65.6 ± 10.6,post-operation score was 87.5 ± 15.3,with a mean improvement of 21.8 ± 13.2 (P ＜ 0.05).According to Harris hip score system,excellent for 30 hips,good for 14 hips,fair for 2 hip and poor for 4 hips.Refer to the Kaplan-Meier survivorship curve,the success rate at 12 months post-operatively was 92％.Radiological changes coincided with clinical changes.Conclusion Core decompressionin combination with nano-hydroxyapatite/ collagen composite rod insertion in corporated with decalcified bone matrix provided a minimally invasive surgical treatment option to treat early stage osteonecrotic hips(stage Ⅰ and Ⅱ) and to prevent femoral heads from collapsing,with clinical outcomes and success rates priorto other commonly used surgical procedures.

Objective To investigate the resistance and ?-lactamase of cefoxitin-resistant Klebsiella pneumoniae. Methods The minimal inhibitory concentrations were determined by standard agar dilution.Isoelectric focusing was used to measure the PI(s) of an isolate,s ?-lactamase,AmpC and ESBLs activity was confirmed by a three-dimensional extract method. Results The resistant rates of 40 strains were as follows: imipenem and meropenem 0.0%,cefepime 20.6%,cefotaxime(22.5%),ceftazidime 60.0%.The most isolates were demonstrated two or more ?-lactamase bands by IEF.Of 39 strains tested,ESBLs was detected in 31(70.5%) strains and AmpC-type?-lactamase in 16(41.0%) strains by three dimensional extract test. Conclusions These cefoxitin-resistant Klebsiella pneumoniae produced two or more ?-lactamases.It is imperative for clinical microbiology laboratories to detect and research ?-lactamases,especially AmpC enzyme.