[摘 要] 目的：探索淋巴细胞亚群对非小细胞肺癌（NSCLC）患者接受程序性死亡受体1（PD-1）单抗联合化疗的疗效预测及预后评估的价值。方法：回顾性分析2022年1月至2023年12月在兰州大学第二医院确诊的接受PD-1单抗联合化疗的50例NSCLC患者的临床资料，收集患者治疗前及治疗2周期后的外周血淋巴细胞亚群（包括总T细胞、CD4+ T细胞、CD8+ T细胞、NK细胞、总B淋巴细胞、CD4+/CD8+ T细胞比值等）的数据。治疗2周期后进行影像学检查评价治疗的疗效，分为疾病控制（DC）组和疾病进展（PD）组。使用卡方检验、秩和检验和Logistic回归分析淋巴细胞亚群表达水平与NSCLC患者近期疗效的关系，采用Kaplan-Meier法分析无进展生存期（PFS）预测疗效的价值。结果：PD-1单抗联合化疗对NSCLC患者的免疫状态产生了显著影响，接受免疫联合化疗后，患者外周血CD4+ T细胞、CD4+/CD8+ T细胞比值均显著升高（均P < 0.01），CD8+ T细胞下降。近期疗效显示，DC组患者血清CD4+ T细胞比例及CD4+/CD8+ T细胞比值均高于PD组（均P < 0.01）。Logistic多因素分析显示，CD4+/CD8+ T细胞比值是PD-1单抗联合化疗疗效的独立影响因素。通过ROC曲线分析，CD4+/CD8+ T细胞比值变化量AUC为0.820 > 0.5，截断值为0.15，CD4+/CD8+ T细胞比值变化量 ≥ 0.15的患者的PFS更长。结论：晚期NSCLC患者外周血中CD4+ T细胞和CD8+ T细胞比例、CD4+/CD8+ T细胞比值可以预测PD-1单抗联合化疗的疗效和预后。

ObjectiveThis study aimed to explore the correlation between the quality of life （QOL） and different traditional Chinese medicine （TCM） syndromes in patients with myasthenia gravis （MG）， identifying potential influencing factors to provide new insights for clinical interventions and improving the QOL of patients with MG. MethodsA questionnaire survey was conducted on 93 adults with MG who visited the Department of Neurology at the Affiliated Hospital of Changchun University of Chinese Medicine from March 2023 to January 2024. Statistical analysis was performed on the clinical data collected using SPSS 24.0 software. ResultsAmong the 93 patients with MG， the average score for myasthenia gravis quality of life-15 （MGQOL-15） was 17.65±6.27， and that for the 36-item short form health survey （SF-36） was （106.13±11.83） scores. The QOL was rated as good for 16 patients and moderate for 77 patients. There were no statistically significant differences in the scores of MGQOL-15， SF-36， and their individual scales by gender or education level. Age showed statistically significant differences in MGQOL-15 and the role physical （RP） scale （P<0.05）， and occupational type showed significant differences in the vitality （VT） scale （P<0.01）. The Myasthenia Gravis Foundation of America （MGFA） classification had statistical significance on the total SF-36 score （P<0.01）， VT scale （P<0.01）， role emotional （RE） scale （P<0.05）， social functioning （SF） scale （P<0.05）， and physical functioning （PF） scale （P<0.01）. Among patients with different TCM syndromes， there were significant differences in MGQOL-15 scores （F=4.919， P<0.01）. Moreover， significant differences were observed in SF-36 scores （P<0.01）， VT scale （P<0.01）， RE scale （P<0.05）， mental health （MH） scale （P<0.01）， and SF scale （P<0.05）. ConclusionFactors affecting the QOL of patients with MG include age， occupational type， and clinical classification of MG. Specifically， a greater impact on the QOL of older patients is observed， while physical laborers have a poorer QOL compared to non-physical laborers. Patients classified as MGFA type Ⅱ and higher have a poorer QOL. Additionally， there is a potential correlation between the QOL and TCM syndromes， with patients presenting with spleen and kidney Qi deficiency having a lower QOL than those with spleen and stomach Qi deficiency or Qi and Yin deficiency， which is particularly evident in the VT， RE， MH， and SF scales.

Cataract extraction combined with intraocular lens implantation is a standard method for treating cataracts, significantly improving patients' vision and quality of life. In this process, the personalized selection of intraocular lenses plays a crucial role in the surgical outcome. Traditional monofocal intraocular lenses provide good distance vision but often have issues with intermediate vision, requiring patients to rely on glasses for correction in daily life. In contrast, multifocal intraocular lenses can meet vision needs at different distances, but are often accompanied by adverse reactions such as halos and glare, affecting the patient's visual experience. In recent years, new types of monofocal intraocular lenses have made significant progress in improving intermediate vision, with relatively fewer side effects. This article aims to review the different types, optical characteristics, and clinical efficacy of monofocal intraocular lenses, providing a reference for ophthalmologists in selecting suitable lenses for patients.

The theory of "turbid pathogen harming the clarity" was proposed by YE Tianshi in his book Wenre Lun, which can be applied to clear orifices diseases such as ear, eye, nose, and mouth. Based on the location and characteristics of vitreous opacity, as well as its understanding by medical professionals throughout history, this article points out that the core pathogenesis of vitreous opacity is "turbid pathogen harming the clarity" and the obstruction of the spirit light, and the basic pathogenesis is: unfavorable liver and gallbladder conditions, damp heat accumulation and turbidity; imbalance of middle jiao, qi deficiency leading to turbidity; kidney failure with yang deficiency, stagnant water and fluids; and stagnation entering the collaterals for an extended time, causing blockage and turbidity. And based on the pathogenesis of "turbid pathogen harming the clarity" , corresponding treatment principles are proposed: soothing liver and promoting bile flow, clearing heat and eliminating turbidity; cultivating soil to produce gold, enhancing clarity and reducing turbidity; tonifying kidney and promoting yang, warming and dispelling turbid pathogens; and removing blood stasis and activating collaterals, dispelling turbidity and unblocking the orifices. Based on the theory of "turbid pathogen harming the clarity" , this article summarizes the pathogenesis and treatment of vitreous opacity, in order to provide new ideas for traditional Chinese medicine treatment of this disease.

Objective To explore the value of pelvic CT angiography(CTA)digital three-dimensional reconstruction model(abbreviated as"three-dimensional model")in the diagnosis of female pelvic mass.Methods A total of 98 patients with pelvic mass who were hospitalized and operated in Xi'an People's Hos-pital(Xi'an Fourth Hospital)from January 2021 to April 2023 were selected.All patients underwent B-ultra-sound and CTA examination before operation,and the original data of CTA were collected.The digital three-dimensional model of pelvic mass was established by three-dimensional reconstruction software,and the source of pelvic mass was judged according to the blood supply of pelvic mass.Taking postoperative pathological di-agnosis as the gold standard,the coincidence rate between different preoperative diagnosis methods(B-ultra-sound,CTA examination and three-dimensional model)was compared.The receiver operating characteristic(ROC)curve was plotted to evaluate the efficacy of different preoperative diagnostic methods in judging the ovarian origin of pelvic tumors.Results A total of 130 pelvic masses were included in 98 patients,and the average maximum diameter of the mass was(71.61±3.03)mm,including 83 ovarian masses and 47 non-ovarian masses.Taking postoperative pathological diagnosis as the gold standard,the diagnostic coincidence rate of the preoperative three-dimensional model was 72.31％,which was higher than that of B-ultrasound(58.46％)and CTA(52.31％),and the differences were statistically significant(P＜0.001).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Kappa value,and area under the ROC curve were 79.51％,91.49％,94.29％,71.67％,83.85％,0.67 and 0.855,respectively,when the three-dimensional model showed that the blood supply of the mass originated from ovarian artery or uterine artery-ovarian branch.Conclusion The three-dimensional model of pelvic CTA can directly display the blood supply source,characteristics of mass,and the relationship between mass and adjacent organs,which can guide the clinical treatment.It has certain clinical value to judge the ovarian origin of pelvic mass by using ovarian artery and uterine artery-ovarian branch.

Objective To explore the relationship between serum silent information regulator 2 related en-zyme(SIRT)3,SIRT6,and sepsis complicated with acute respiratory distress syndrome(ARDS)and progno-sis.Methods Sixty-eight patients with sepsis complicated with ARDS admitted to the Baoding First Central Hospital from March 2020 to February 2022 were selected as the study objects,and were divided into mild group,moderate group and severe group according to the criteria of mild,moderate and severe ARDS.Accord-ing to the prognosis within 28 days,the patients were divided into survival group and death group.The levels of serum SIRT3 and SIRT6 were detected by enzyme-linked immunosorbent assay.The sequential organ fail-ure assessment(SOFA)scores,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores,the levels of serum SIRT3 and SIRT6 in each group were compared.The clinical data of patients were collected,the influencing factors of mortality in patients with sepsis complicated with ARDS was analyzed by univariate and multivariate Logistic regression.The predictive value of serum SIRT3 and SIRT6 of mortality in patients with sepsis complicated with ARDS was analyzed by receiver operating characteristic(ROC)curve.Results The levels of serum SIRT3 and SIRT6 in moderate group and severe group were lower than those in mild group,the scores of SOFA and APACHE Ⅱ were higher than those in mild group,the levels of serum SIRT3 and SIRT6 in severe group were lower than those in moderate group,and the scores of SOFA and APACHE Ⅱwere higher than those in moderate group,with statistical significance(P＜0.05).There were statistically significant differences in age,mechanical ventilation time,lactate,arterial oxygenation index[arterial partial pressure of oxygen(PaO2)/inhaled oxygen concentration(FiO2)],C reactive protein(CRP),interleukin(IL)-6,SIRT3,SIRT6,SOFA score and APACHE Ⅱ score between the two groups(P＜0.05).Longer mechanical ventilation time,higher lactic acid,higher CRP,higher IL-6,higher SOFA score and higher APACHE Ⅱ score were all risk factors for death in sepsis complicated with ARDS within 28 days,while larger PaO2/FiO2,high-er SIRT3 and higher SIRT6 were protective factors(P＜0.05).ROC curve results showed that the area under the curve and 95％CI of serum SIRT3,SIRT6 levels,SOFA score and APACHE Ⅱ score were 0.706(0.493-0.922),0.722(0.497-0.954),0.753(0.570-0.922),0.710(0.442-0.952)and 0.872(0.761-0.976),respectively when applied alone and in combination.Conclusion Serum SIRT3 and SIRT6 levels are decreased in patients with sepsis complicated with ARDS,and the lower the serum SIRT3 and SIRT6 levels are as the disease worsens,the two can help predict the prognosis of patients with sepsis complicated with ARDS.

Objective:To explore the feature of FOS expression in oxytocin-and vasopressin-positive neurons in the hypothalamic paraventricular nucleus(PVN)under different status of diabetes mellitus(DM).Methods:Intraperito-neal injection of vehicle or STZ in mice was conducted to establish control or diabetes model.Mechanical sensitivity was evaluated by von Frey filament tests to distinguish diabetic neuropathic pain(DNP)from without-pain group(DWP).The expression of FOS,oxytocin(OXT)-and vasopressin(VP)-positive neurons,as well as their double labeling was detected by immunohistochemical and immunofluorescent staining.Cell counting and comparison were made in groups.Results:FOS expression was easily detected in the PVN in the three groups(Control group,DNP group and DWP group)at 7 days,while that in DWP and DNP groups at 28 days was hardly detectable,with the number being signifi-cantly different from the 7 days group(P＜0.05 or 0.001).Likewise,compared with the control group,immunofluo-rescent signals for VP and OXT staining in the DNP and DWP groups also showed a trend of weakening as the modeling time increased(P＜0.05).The cell counting after double staining for VP or OXT with FOS showed that,in the DWP group at 7 days,the number of VP and FOS double-labeled neurons was 74.33±22.10,accounting for(56.64± 7.52)％of VP-positive cells,whereas the double labeling rate for OXT and FOS was only(10.44±3.14)％.In the DNP group at 7 days,the number of OXT and FOS double-labeled neurons was 51.00±31.80,accounting for(18.50 ±9.51)％of OXT-positive neurons,whereas the double labeling rate for VP and FOS was only(9.34±3.27)％.In contrast to these changes in 7 days group,the expression of FOS decreased sharply in the group of 28 days,thereby al-most no double-labeled neurons.Conclusion:The plasticity changes of oxytocin-and vasopressin-positive neurons in the PVN are different depending on the status of pain and non-pain,and the stage of disease progression.Understanding the changes is of great significance for unravelling the neural mechanism of diabetes and its complications.

BACKGROUND:The application of miniscrew in adolescents is increasing day by day,but at present,there are few studies on bone mass in the external oblique line of the mandible in adolescents at home and abroad,and there is no systematic study on bone mass in the external oblique line of the mandible in adolescents in different growth and development periods. OBJECTIVE:To measure the bone mass in the external oblique line of the mandible in adolescents with different cervical vertebral bone ages using a cone-beam CT and to investigate the difference of bone mass in the external oblique line of the mandible in adolescents with different cervical vertebral bone ages and the correlation between bone mass in this area and the cervical vertebral bone age. METHODS:The cone-beam CT data of 105 adolescent patients before orthodontic treatment were collected and divided into CS3 group(n=24),CS4 group(n=26),CS5 group(n=29)and CS6 group(n=26)using the cervical vertebral maturation method.The adolescent mandibular buccal shelf was reconstructed by Mimics Medical 21.0 software.The width of buccal bone at 6 and 11 mm under the cemento-enamel junction and the bone height at 4 and 5 mm buccal to the cemento-enamel junction of right mandibular first and second molars were measured.The measured data were statistically analyzed.The measurement was made on four planes:plane 1 is the plane where the proximal mesial root of the mandibular right first molar is located;plane 2 is the plane where the distal mesial root of the mandibular right first molar is located;plane 3 is the plane where the proximal mesial root of the mandibular right second molar is located;and plane 4 is the plane where the distal mesial root of the mandibular right second molar is located. RESULTS AND CONCLUSION:In each group,the bone width on the buccal side of the external oblique line increased gradually from the first molar proximally to the second molar distally in adolescents,and the width of buccal bone at 6 and 11 mm under the cemento-enamel junction showed significant difference among different layers(P<0.05).The bone width of buccal bone at 11 mm under the cemento-enamel junction was greater than that at 6 mm.The bone height on the buccal side of the external oblique line increased gradually from the first molar proximally to the second molar distally in all four groups,and the bone height at 4 and 5 mm buccal to the cemento-enamel junction showed significant differences at different layers(P<0.05).The bone height at 4 mm buccal to the cemento-enamel junction was greater than that at 5 mm.On the fourth plane,the bone width at 11 mm buccal to the cemento-enamel junction was smaller in the CS3,CS4,and CS5 groups than in the CS6 group(P<0.05).On the third plane,the bone heights at 4 mm and 5 mm buccal to the cemento-enamel junction were smaller in the CS3 and CS4 groups than in the CS6 group(P<0.05).On the fourth plane,the bone height at 5 mm buccal to the cemento-enamel junction was smaller in the CS3 and CS4 groups than in the CS6 group(P<0.05).On the fourth plane,the bone height at 4 mm buccal to the cemento-enamel junction was smaller in the CS3 group than in the CS6 group(P<0.05).Spearman correlation analysis showed that there was no correlation between bone mass and the cervical vertebral bone age,except that there was a weak correlation between bone mass at some measurement sites and cervical vertebral bone age.To conclude,the bone mass in the external oblique area of the mandible in adolescents does not change significantly with the increase of cervical vertebral bone age.The buccal side of the mesial root and distal root of the mandibular second molar in the external oblique area of CS3-CS6 adolescents meets the requirement of bone mass for miniscrew implantation,which is a site available for miniscrew implantation.

BACKGROUND:Previous literature reported that the fusion cage moved more than 2 mm from its original position,which means that the fusion cage moved backward.At present,clinical observation has found that the factors leading to the displacement of the fusion cage are complex,and the relationship between these factors and the cage retropulsion is not clear. OBJECTIVE:To explore the risk factors related to cage retropulsion after lumbar interbody fusion. METHODS:Retrospective analysis was conducted in 200 patients who underwent transforaminal lumbar interbody fusion surgery with a polyetheretherketone interbody fusion from February 2020 to February 2022.According to the distance from the posterior edge of the vertebral fusion cage to the posterior edge of the vertebral body after the operation(the second day after the removal of the drainage tube)and 1,3,6 and 12 months after the operation,patients were divided into cage retropulsion group(≥2 mm)and cage non-retropulsion group(<2 mm).The factors that may affect cage retropulsion,such as age,gender,body mass index,bone mineral density,operation time,bleeding,endplate injury,preoperative and postoperative interbody height,cage implantation depth,cage size,and segmental anterior convexity angle,were analyzed by univariate and logistic regression analysis. RESULTS AND CONCLUSION:(1)Posterior displacement of the fusion cage occurred in 15 cases(15/200).The differences in basic information such as age and body mass index between the two groups were not statistically significant.(2)The results of the univariate analysis were that gap height difference,time to wear a brace,segmental anterior convexity angle difference,bone mineral density,and age were related to posterior migration of the cage.(3)The results of logistic regression analysis were that cage size,endplate injury condition,and depth of cage implantation were risk factors for cage retropulsion.(4)These findings suggest that cage retropulsion after lumbar interbody fusion is caused by multiple factors,including segmental anterior convexity angle difference,bone mineral density,cage size,endplate damage,time to wear a brace,and depth of cage implantation.

BACKGROUND:Traditional lateral cephalometric radiographs always suffer from some problems,such as magnification distortion,left and right overlap inconsistency and so on,while the cone-beam CT can truly display the three-dimensional structure of the craniofacial region.Performing three-dimensional reconstruction of cone-beam CT and then transforming the cone-beam CT in the selected area into the two-dimensional image can make the overlap between the left and right sides consistent and reduce the influence of surrounding tissue structures. OBJECTIVE:To explore the consistency of quantitative analysis of cervical vertebral bone age between two kinds of cone-beam CT transformed two-dimensional images with different integrated thicknesses and traditional lateral cephalometric radiographs. METHODS:The cone-beam CT and lateral cephalometric radiograph data of 118 adolescent orthodontic patients were collected.Firstly,the cone-beam CT image was reconstructed in 3D imaging software.After reconstruction,two types of cone-beam CT images with different integrated thicknesses were selected in the sagittal interface and transformed into two-dimensional images,which were named ICB-1 and ICB-2,respectively.The Zhibeiyun system was used to measure and calculate the angle between the concave base of the second cervical vertebra and the lower edge of the vertebral body(@2),the ratio of the third cervical spine to the posterior height(AH3/PH3),the ratio of height to width of the fourth cervical spine(H4/W4)in lateral cephalometric radiograph,ICB-1,ICB-2 and the cervical vertebral bone age.After an interval of two weeks,20 adolescents were randomly selected to repeat the above measurements.The intraclass correlation coefficient(ICC)method was used to evaluate the repeatability of the three images in measuring cervical bone age.Paired t-test was used to analyze the consistency of cervical bone age measurements between the three images.The Kappa test was used to analyze the consistency of cervical vertebral bone age staging assessment between the three images. RESULTS AND CONCLUSION:(1)ICC of AH3/PH3 in the lateral cephalometric radiograph group was<0.9,and the ICC of other measurement items in each group was>0.9.(2)Paired t-test results showed that there were statistical differences in AH3/PH3 and H4/W4 between the ICB-1 group and lateral cephalometric radiograph group and between the ICB-1 group and ICB-2 group(P<0.05),and there were no statistically significant differences in the other items between the three groups(P>0.05).(3)The Kappa test results showed that the Kappa coefficients of the two groups were all more than 0.8 according to the staging of cervical vertebral bone age in three groups(P<0.001).(4)It is indicated that the repeatability of ICB-1 and ICB-2 in the measurement of cervical vertebral bone age is better than that of lateral cephalometric radiographs.Lateral cephalometric radiographs,ICB-1 and ICB-2 have good consistency in the measurement of cervical vertebral bone age,but considering the integrity of cervical vertebra structure,ICB-2 is more suitable for quantitative analysis of cervical vertebral bone age than ICB-1.