Primary small cell carcinoma of esophagus （PSCCE） is a rare and highly aggressive neuroendocrine tumor， accounting for 0.05% to 3.1% of all esophageal malignancies. Its biological characteristics are similar to those of small cell lung cancer， with highly aggressive behavior and early dissemination tendency. It often metastasizes rapidly through lymphatic and hematogenous pathways.The prognosis is extremely poor， with a 5-year overall survival rate of less than 15%. There are no large-scale randomized controlled trials， and no standard treatment strategies have been established. In recent years， the treatment of limited-stage PSCCE has become a focal point of research. In traditional treatment paradigms， endoscopic therapy is feasible for very early-stage cases， while radical surgery serves as the primary approach for relatively early-stage patients. For locally advanced cases， two predominant treatment modalities are commonly employed in clinical practice： a surgery-based comprehensive treatment regimen and a radical chemoradiotherapy-centered therapeutic protocol， with no definitive conclusion yet reached regarding the optimal treatment strategy. Concurrently， emerging therapeutic strategies such as immunotherapy and molecularly targeted therapy have demonstrated remarkable clinical efficacy， thereby providing novel therapeutic opportunities for limited-stage PSCCE. This article aims to review the recent advances in the treatment of limited-stage PSCCE， summarize the current diagnostic and therapeutic landscape， and outline future directions in this field.

Objective To investigate the mechanism of polyethylene glycol losenatide in improving non-alcoholic fatty liver disease by regulating lipophagy. Methods （1） 32 C57BL/6 male mice were fed normally for 1 week and randomly divided into 4 groups with 8 mice in each group. Normal control group （fed normal diet）， Normal + GLP-1RA （intraperitoneal injection of polyethylene glycol losenatide 0.3 mg/kg q3d）， High fat group （fed with high fat diet）， High-fat + GLP-1RA （on the basis of high-fat diet， intraperitoneally injected polyethylene glycol losenatide 0.3 mg/kg q3d）， The molding lasts 16 weeks. Body weight， blood glucose and glucose tolerance test （GTT） were measured at the end of 16 weeks. Serum total cholesterol （TC）， triglyceride （TG）， low density lipoprotein （LDL）， high density lipoprotein （HDL） and other indexes were detected by Enzyme-linked immunosorbent assay （ELISA）， liver pathological changes were observed by Hematoxylin-eosin （HE） and oil red O sections， and the expression of microtubule-associated protein light chain 3 （LC3）， autophagy adaptor protein （P62）， and transcription factor EB （TFEB）. in liver were detected by Western blot （Wb）. （2） The cell was divided into normal group （treated with bovine serum albumin， BSA）； Normal + polyethylene glycol losenatide group （BSA+100 nmol/L GLP-1RA）， High fat group （0.5 mmol/L PA）； High fat + polyethylene glycol losenatide group （0.5 mmol/L PA+100 nmol/L GLP-1RA）. After 24 h， the steatosis was observed by oil red O staining， the levels of TG in the supernatant were detected， Wb analysis was performed to detect protein expression levels of LC3， TFEB， and P62. Reverse transcription quantitative PCR （RT-qPCR） was used to measure mRNA levels of lipid synthesis-related factors. Results （1） Compared with normal control group， the body weight and blood glucose of mice in the high fat group increased significantly （P < 0.01）， reduced glucose tolerance （P < 0.01）， the levels of TC，TG and LDL in serum in liver of high fat group were significantly increased （P < 0.01）， while HDL was significantly decreased （P < 0.01）. Compared with high fat group，blood sugar in mice， the levels of TC， TG and LDL in serum and P62 in liver of high fat + GLP-1 group were significantly decreased （P < 0.01）； Glucose tolerance， HDL and and the protein expressions of LC3， TFEB were significantly increased （P < 0.01）. Compared with normal control group， the above indexes in normal + GLP-1 group were not significantly changed （P > 0.05）. （2） In vitro， The NAFLD HepG2 cell model was successfully constructed with 0.5 mmol/L PA. After 24 h of PA treatment， intracellular lipid drops were significantly increased （P < 0.01）， intracellular TG and the mRNA levels of lipid synthesis-related factors in the cells were increased （P < 0.01）. High fat + GLP-1 group improved the fatty degeneration induced by high fat， and the changes of the above indexes showed an opposite trend but the expression of LC3， TFEB were significantly increased （P < 0.01）， lipid regulatory factor P62 protein in liver were decreased （P < 0.01）. Conclusion Polyethylene glycol losenatide can improve non-alcoholic fatty liver disease by regulating lipophagy.

Objective To investigate the effects and underlying mechanisms of total flavonoids of sarcandra glabra （TFFSG） on bone marrow mesenchymal stem cells （BMSCs） and their derived exosomes in immune thrombocytopenia （ITP）， with a focus on promoting megakaryocyte differentiation and maturation. Methods BMSCs induced by rabbit anti?rat platelet serum （APS） were divided into five groups： a blank control group， an ITP?BMSCs model group， and three TFFSG intervention groups with low （1.95 μg/mL）， medium （3.90 μg/mL）， and high doses （7.80 μg/mL）. The apoptosis rates and the expression levels of apoptosis?related proteins?B?cell lymphoma 2 （Bcl?2）， Bcl?2?associated X protein （BAX）， and Cysteinyl aspartate?specific proteinase?3 （Caspase?3）?were assessed. Exosomes were isolated from the blank control group （NC?BMSCs?Exos）， the ITP?BMSCs model group （ITP?BMSCs?Exos）， and the medium?dose TFFSG group （TFFSG?BMSCs?Exos）. Each group's exosomes （5 μg/mL） were co?cultured with megakaryocytic lineage Dami cells for 96 hours. Flow cytometry was employed to evaluate the expression of megakaryocytic differentiation markers （CD41a， CD42b， CD61） and the proportion of polyploid cells （≥ 4 N） in each group. Western Blot analysis was conducted to examine the expression of p?MEK1/2， MEK1/2， p?ERK1/2， and ERK1/2 across all groups. Results Compared with the ITP?BMSCs model group， the apoptosis rates in all TFFSG intervention groups were significantly reduced （P < 0.01）. In the medium? and high?dose TFFSG groups， BAX and Caspase?3 expression levels were markedly downregulated， whereas Bcl?2 expression was upregulated （P < 0.05， P < 0.01）. Compared with the ITP?BMSCs?Exos group， the TFFSG?BMSCs?Exos group demonstrated increased expression of CD41a⁺， CD42b⁺， and CD61⁺， a higher proportion of polyploid cells （≥ 4 N） （P < 0.05）， as well as elevated ratios of p?MEK1/2 to MEK1/2 and p?ERK1/2 to ERK1/2（P < 0.05）. Conclusion TFFSG inhibits apoptosis of ITP?state BMSCs in vitro and promotes megakaryocyte differentiation and polyploidization maturation through BMSC?derived exosomes by activating the MEK1/2?ERK1/2 signaling pathway.

Objective To evaluate whether 6-gingerol（6G）can inhibit fibrosis and improve the cardiac and renal function and in rats with cardiorenal syndrome. Methods In the in vitro experiments of this study， the incorporation of isotope-labeled amino acids was used to detect the intervention of 6-gingerol on normal rat kidney-49F （NRK-49F） and normal rat kidney-52E （NRK-52E） cells. 68 male SD rats weighing 200 ~ 250 g were used to establish a rat model of cardiorenal syndrome by ligating the left anterior descending coronary artery and performing 5/6 nephrectomy. The rats were randomly divided into a control group， a model group， a low dose 6-gingerol group （6 mg/kg）， a high dose 6-gingerol group （30 mg/kg）， and a losartan potassium group （20 mg/kg）. The 6-gingerol group received intraperitoneal injection of 6-gingerol， while the control group and model group received intraperitoneal injection of an equal amount of physiological saline. The losartan group received oral administration of losartan potassium for a total of 6 weeks. After successful modeling， blood samples were taken for biochemical and cardiac ultrasound examinations. After the experiment， blood， heart， and kidney samples were taken for Masson， immunohistochemistry， and Western blot. Results 6-gingerol 20 μmol/L can reduce NRK-49F collagen synthesis and inhibit NRK-52E protein synthesis. Biochemical results showed that the serum creatinine， urea nitrogen， and brain natriuretic peptide （BNP） levels of rats in the low and high dose 6-gingerol groups and the losartan group were all reduced， with high dose 6-gingerol groups and losartan group showing the most significant decrease （P < 0.05）. Echocardiographic parameters showed that the 6-gingerol group and losartan potassium group improved cardiac contractile function and ventricular remodeling in rats （P < 0.05）. Masson staining and Western Blot showed renal collagen deposition， with reduced expression of collagen I and α-SMA （P < 0.05）. Immunofluorescence showed a decrease in the expression of renal collagen deposition I， α-SMA， and TGF-β1 （P < 0.05）. Conclusion 6-Gingerol may improve the cardiac and renal function and renal fibrosis in rats with cardiorenal syndrome.

Objective To investigate the effects of Ras?related protein Rab?2B （RAB2B） on the biological behaviors of pancreatic cancer cells and elucidate its underlying mechanism. Methods PANC?1 cells， which exhibit relatively high RAB2B expression， and BXPC?3 cells， which display relatively low RAB2B expression， were selected from five pancreatic cancer cell lines. RAB2B?siRNA and pcDNA3.1?RAB2B plasmids were transfected into PANC?1 and BXPC?3 cells using a cell transfection technique. The CCK?8 assay was employed to evaluate the proliferative capacity of pancreatic cancer cells following RAB2B intervention. Wound healing and Transwell chamber assays were utilized to assess the migratory and invasive capabilities of pancreatic cancer cells. Additionally， the mRNA and protein expression levels of RAB2B， NF?κB， and Fibronectin 1 （FN1） were analyzed by qRT?PCR and Western blot （WB）， respectively. Results RAB2B mRNA and protein expression levels were significantly downregulated in PANC?1 cells following transfection （P < 0.05）. CCK?8 assay results demonstrated that the proliferative capacity of PANC?1 cells was markedly reduced （P < 0.05）， and the wound?healing ability was substantially impaired （P < 0.01） upon RAB2B knockdown. Transwell assays revealed a significant decrease in cell migration （P < 0.01）， while Western blot analysis indicated that the expression levels of phosphorylated p65 and FN1 were notably diminished （P < 0.01）. Conversely， overexpression of RAB2B reversed these aforementioned alterations. Conclusions Knockdown of RAB2B in PANC?1 cells significantly suppresses cell proliferation and migration， whereas overexpression of RAB2B in BXPC?3 cells markedly promotes these processes. This effect is likely mediated through the activation of the NF?κB signaling pathway and the subsequent regulation of FN1 expression.

Objective To explore the molecular mechanism of histone acetyltransferase （p300） mediated peroxisome proliferator activated receptor-γ（PPAR-γ） influencing diabetes retinopathy through lipid peroxidation. Methods Diabetes models were established in 65 SD rats by intraperitoneal injection of streptozotocin， and the remaining 10 SD rats were simultaneously intraperitoneally injected with an equal amount of sterile physiological saline and recorded as the normal group. The successfully modeled rats were randomly divided into six groups： p300 upregulated group， p300 downregulated group， PPAR-γ upregulated group， PPAR-γ downregulated group， empty control group， and model group. Except for the normal group and the model group （which were simultaneously injected with an equal amount of sterile physiological saline through vitreous injection）， each group was injected with pcDNA-p300， si-p300， pcDNA PPAR-γ， si-PPAR-γ， and pcDNA adenovirus solution through vitreous injection. Five rats were selected from each group， and Evans blue method was used to detect the degree of damage to the left eye blood retinal barrier. The fully automated biochemical analyzer detects lipids in each group， including triglycerides （TG）， cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， as well as peroxidation reaction indicators such as superoxide dismutase （SOD） activity， malondialdehyde （MDA） content， and reactive oxygen species （ROS） levels. Five rats from each group were selected to take retinal tissue from their right eyes for hematoxylin eosin （HE） staining to observe pathological changes. After the remaining rats in each group were euthanized by decapitation， real time quantitative polymerase chain reaction （RT-qPCR） was used to detect the expressions of p300， PPAR-γ， protein kinase C β （PKC β）， and adaptor protein p66Shc （P66Shc） messenger RNA （mRNA） in the left eye retinal tissues， and Western blot was used to detect the expression of the aforementioned proteins and the phosphorylation level of P66Shc in the retinal tissues of the right eye. Results Compared with the normal group， the Evans blue concentrations， albumin penetrations， serum TG， TC， LDL-C， MDA contents， and ROS levels increased in all other groups， while HDL-C， SOD activity， p300， PPAR-γ， PKC β， P66Shc expressions， and P66Shc phosphorylation levels decreased （P < 0.05）. Compared with the model group， the p300 downregulated group showed a decrease in p300 expression （P < 0.05）， the Evans blue concentration， albumin permeability， serum TG， TC， LDL-C， MDA contents， and ROS levels were all increased in the p300 downregulated group and PPAR-γ downregulated group， while HDL-C and SOD activity， PPAR-γ， PKC β， P66Shc expression， and P66Shc phosphorylation levels were all decreased （P < 0.05）. The p300 upregulated group showed an increase in p300 expression （P < 0.05）， and the Evans blue concentration， albumin permeability， serum TG， TC， LDL-C， MDA contents， and ROS levels all decreased in the p300 upregulated group and PPAR-γ upregulated group， while HDL-C and SOD activity， PPAR-γ， PKC β， P66Shc expressions， and P66Shc phosphorylation levels all increased （P < 0.05）. There were no statistically significant differences in blood retinal barrier damage， lipid and peroxidation indicators， PPAR-γ， PKC β， P66Shc expression， and P66Shc phosphorylation between the p300 downregulated group and PPAR-γ downregulated group， p300 upregulated group and PPAR-γ upregulated group， unloaded control group and model group （P > 0.05）. Normal group rats showed no pathological changes in retinal tissues， while significant pathological changes were observed in the model group and empty control group. Severe pathological changes were observed in the p300 downregulated group and PPAR-γ downregulated group， while slight pathological changes were observed in the p300 upregulated group and PPAR-γ upregulated group. Conclusion Up-regulation of p300 can positively mediate PPAR-γ to control lipid peroxidation and alleviate diabetes retinopathy， while down-regulation of p300 can promote diabetes retinopathy by inhibiting PPAR-γ to activate lipid peroxidation.

Objective To investigate the expression characteristics and clinical diagnostic value of programmed death receptor 1 （PD-1） and its corresponding ligand （PD-L1） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods One hundred and sixty COPD patients who visited Dongzhimen Hospital of Beijing University of Chinese Medicine from April 2024 to November 2024 were included and divided into an acute exacerbation group of 100 cases and a stable group of 60 cases according to the severity of the disease. Additionally， 40 healthy volunteers during the same period were recruited as the control group. The general clinical data of the patients were collected. Chronic Obstructive Pulmonary Disease Assessment Test （CAT） and Modified Medical Research Council Dyspnea Questionnaire （mMRC） Scale were used to test the severity of the disease； respiratory function testing was performed and fasting venous blood was collected for serum PD-1 and PD-L1 testing. Pearson correlation was used to analyze the correlation between serum PD-1， PD-L1， CAT， and mMRC， and multiple logistic regression analysis to identify the influencing factors of AECOPD. Receiver operating characteristic （ROC） curve was drawn to evaluate the diagnostic value of serum PD-1 and PD-L1 level for AECOPD. Results Serum PD-1 level in the stable COPD group and AECOPD group was significantly increased compared with that in the control group， while serum PD-L1 level was significantly decreased， showing statistical significance （P < 0.05）； The level of PD-1 gradually increased with the grading of lung function and the deterioration of AECOPD， with statistical significance （P < 0.05）； Pearson correlation showed that serum PD-1 level was positively correlated with CAT scores in COPD patients， while negatively with CAT scores， showing statistical significance （P < 0.05）； Multiple logistic regression analysis showed that elevated levels of serum interleukin-6 （IL-6）， neutrophil to lymphocyte ratio （NLR）， and PD-1 were risk factors for AECOPD， while elevated level of PD-L1 was protective factor for AECOPD （P < 0.05）； ROC curve showed that the levels of PD-1， PD-L1， IL-6， NLR， and the area under the ROC curve （AUC） for their combined prediction of AECOPD diagnosis were 0.884， 0.867， 0.868， 0.802， and 0.995， respectively. Conclusion Serum PD-1 and PD-L1 in AECOPD patients have presented certain expression characteristics， with elevated PD-1 level while decreased PD-L1 level. Both have good clinical diagnostic value for AECOPD.

Objective To investigate the impact of adductor canal block （ACB） in combination with popliteal plexus block （PPB） on patients undergoing arthroscopic anterior cruciate ligament reconstruction （ACLR）. Methods Patients who underwent primary unilateral ACLR treatment at our hospital between March 2022 and November 2023 were recruited as the research subjects. They were randomly allocated into the ACB group （n = 43 cases） and the combined PPB group （n = 47 cases） using a coin?toss method. Patients in the ACB group received ACB， while those in the combined PPB group received ACB in conjunction with PPB. The pain intensity， analgesic effect， adverse reactions， and postoperative status following ACLR were compared between the two groups. Results The Visual Analogue Scale （VAS） scores of the combined PPB group were significantly lower than those of the ACB group at 4 hours， 8 hours， 12 hours， 24 hours， and 48 hours post ACLR （P < 0.05）. Repeated measures analysis of variance of VAS scores in the resting and active exercise states of ACLR patients in the two groups revealed that the group effect had F?values of 162.052/142.173 and P?values of 0.000/0.000， the time effect had F?values of 74.223/65.515 and P?values of 0.000/0.000， and the interaction effect had an f?value of 4.707/. The cumulative dose of sufentanil， the frequency of postoperative analgesia， and the proportion of posterior knee pain in the combined PPB group were all lower than those in the ACB group （P < 0.05）. There was no significant difference in adverse reactions between the ACB group and the combined PPB group （P > 0.05）. The hospitalization duration and the time to achieve active straight leg raise in the combined PPB group were shorter than those in the ACB group， while the analgesic satisfaction score was higher than that in the ACB group （P < 0.05）. Conclusion The combination of ACB and PPB in ACLR can effectively alleviate postoperative pain， reduce the requirements for sufentanil and analgesic interventions， enhance patient satisfaction， shorten the hospitalization period and the time to achieve active straight leg raise， and promote early patient recovery without increasing the risk of adverse reactions.

Objective To explore the characteristics and influencing factors of taste abnormalities in patients with differentiated thyroid cancer （DTC） after ¹³¹I treatment. Methods A total of 206 DTC patients who received ¹³¹I treatment in the First Affiliated Hospital of Nanchang University from August 2023 to December 2023 were followed up for taste abnormalities， dry mouth， and parotid gland swelling. General clinical data including sex， age， and tumor TNM staging were collected. Based on the presence of taste abnormalities， the patients were divided into abnormal taste group and normal taste group. The differences in general data between the two groups were compared， and multiple logistic regression analysis was used to explore the influencing factors of taste abnormalities. Results Totally， 42.23% of the patients experienced taste abnormalities， including 68 patients with varying degrees of reduced taste， 3 patients with a loss of taste， 6 patients with taste sensitivity， 24 patients with taste hallucinations， and 14 patients with both reduced taste and taste hallucinations. The shortest time for the onset of taste abnormalities was 2 days after ¹³¹I treatment， and the longest time was 20 days，with a median time of 7 days； The duration ranged from a minimum of 3 days to a maximum of 60 days， with a median of 14 days. The proportion of dry mouth and parotid gland swelling in patients with abnormal taste was higher than that in those with normal taste， showing statistical significance （P = 0.004， 0.014， respectively）. However， there was no statistical significance in terms of sex age， and tumor TNM stage （P > 0.05）. Multivariate logistic regression analysis showed that dry mouth and parotid gland swelling were risk factors for taste abnormalities in DTC patients treated with ¹³¹I （P = 0.007， 0.024， respectively）. Conclusion Abnormal taste is a common adverse reaction in DTC patients after ¹³¹I treatment， typically transient， with a median onset time of 7 days post-treatment and a median duration of 14 days. The primary manifestation is reduced taste， with dry mouth and parotid gland swelling identified as risk factors for its occurrence.

Objective To study the application of autologous natural killer （NK） cells in the treatment of advanced renal cell carcinoma and the changes of immune function and tumor markers in patients. Methods 61 patients with advanced renal cell carcinoma admitted to Gansu Wuwei Tumour Hospital from March 2023 to April 2024 were divided into targeting group （31 cases， given supportive treatment combined with sunitinib malate capsules） and cell group （30 cases， autologous NK cells combined with targeting group） according to the patient 's willingness to treat combined with propensity score matching. 6 weeks was a treatment cycle， and all patients were treated for 4 cycles. The clinical efficacy of the two groups after 4 cycles of treatment and the occurrence of adverse reactions during treatment were statistically analyzed. The levels of serum cytokines， tumor markers， lymphocyte function and immune function were compared between the two groups before and after 4 cycles of treatment. Results After 4 cycles of treatment， the objective remission rate and disease control rate in the cell group were higher than those in the targeting group （P < 0.05）. After 4 cycles of treatment， the levels of serum hypoxia-inducible factor-1α （HIF-1α）， vascular endothelial growth factor （VEGF）， platelet-derived growth factor （PDGF）， carcinoembryonic antigen， carbohydrate antigen 125， carbohydrate antigen 199 and alpha-fetoprotein in the two groups were lower than those before treatment， and those in the cell group were lower than those in the targeting group （P < 0.012 5）. After 4 cycles of treatment， the levels of serum interleukin-2， interleukin-6， tumor necrosis factor-β， interferon-γ， peripheral blood CD3⁺， CD4⁺， NK cells and CD4⁺/CD8⁺in the two groups were higher than those before treatment. The levels of serum interleukin-2， tumor necrosis factor-β， interferon-γ， peripheral blood CD3⁺ and NK cells in the cell group were higher than those in the targeting group （P < 0.012 5）. The level of CD8⁺ in peripheral blood was lower than that before treatment （P < 0.012 5）， but there was no significant difference between the two groups （P > 0.012 5）. During the treatment， there was no significant difference in the incidence of diarrhea， nausea and vomiting， alopecia， liver function damage， decreased platelet level and decreased neutrophil level between the cell group and the targeting group （P > 0.05）. Conclusion The treatment of advanced renal cell carcinoma with autologous NK cells could improve the level of serum cytokines， reduce the level of tumor markers， regulate the function of lymphocytes and immune function， and had a good therapeutic effect. At the same time， it would not increase the incidence of adverse reactions， and the safety was good.

Objective To analyze the risk factors of tracheal reintubation after total aortic arch replacement and to provide evidence for the prevention of tracheal reintubation after total aortic arch replacement. Methods From January 1， 2019 to June 31， 2020， 162 patients who underwent total aortic arch replacement in the Department of Cardiac Surgery of a tertiary grade-A hospital in Guangdong Province were randomly selected and divided into reintubation group （n = 27） and control group （n = 135） based on the occurrence of tracheal reintubation. The risk factors were analyzed by univariate and multivariate logistic regression. Results Among the 162 patients， 27 cases （16.7%） had tracheal reintubation. Compared with those in the control group， the length of ICU stay and hospitalization cost in the reintubation group were significantly increased （P < 0.001）. Univariate analysis indicated that there were significant differences in terms of age， glomerular filtration rate， diabetes mellitus， ventilator time， pulmonary infection， liver insufficiency， hypoxemia， delirium and cerebrovascular accident （P < 0.05）. Multivariate analysis showed age （OR = 1.069，P = 0.038）， pulmonary infection（OR = 5.227， P = 0.047）， delirium （OR = 7.079， P = 0.011）， and ventilator use time （OR = 1.006，P = 0.001） were independent risk factors for tracheal reintubation after total arch replacement. A regression equation was established as follows： ［Logit （P）=-8.885 + 0.066 × age + 1.654 × pulmonary infection + 1.957 × delirium + 0.006 × time］ of first ventilator use. The area under the ROC curve of the subjects in this model was 0.931（95%CI： 0.884 ~ 0.979）， P < 0.001； The results of Hosmer-Lemeshow test （χ² = 4.76 and P = 0.782） indicated that the model had high accuracy. Conclusion Age， pulmonary infection， delirium and ventilator use time are independent risk factors for tracheal reintubation after total aortic arch replacement.

Objective To determine the predictive power of negative fluid balance in the risk of death in septic shock patients after fluid resuscitation therapy. Methods The medical records of patients with septic shock admitted to the Intensive Care Department of Tianjin Medical University Cancer Hospital from March 2022 to December 2024 were retrospectively collected， and the final outcome was defined as death within 28 days during hospitalization. The study objects were randomly divided into the training set and the validation set， and then the model was built by Logistic regression method， and the nomogram and receiver operating characteristic curve （ROC curve） were drawn. Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model， and the calibration curve was drawn to evaluate the differentiation degree of the prediction model. Decision curve analysis （DCA） was used to test the efficiency of the prediction model. Results A total of 286 patients with septic shock were included in the study， including 200 in the training set and 86 in the verification set， which were comparable. Multivariate Logistic regression analysis showed that negative fluid balance， APACHE II score and SOFA score were independent risk factors for poor survival and prognosis of ICU septic shock patients （all P < 0.05）. Based on the results of multivariate Logistic regression analysis， a nomogram was constructed to predict the survival and prognosis of patients with septic shock in ICU. In the training set and validation set， the area under the curve （AUC） of the ROC curve prediction model was 0.83 （95%CI：0.73 ~ 0.93） and 0.83 （95%CI：0.66 ~ 1.00）， respectively. Hosmer-Lemeshow calibration curve has a good fit （training set P= 0.169； The verification set P = 1.000） is not significant. DCA showed that when the threshold probability of patients was 0.05~0.70， it was more beneficial to use the nomogram prediction model to predict the risk of death in septic shock patients. Conclusion Negative fluid balance after fluid resuscitation is associated with survival and prognosis of patients with septic shock. The predictive model of mortality risk of patients with septic shock was established by combining APACHEⅡ score and SOFA score， which has good predictive ability and clinical practicability.

Objective To compare the effects of non-invasive intermittent oxygen-driven nebulization， non-invasive intermittent air-driven nebulization， and non-invasive simultaneous air-driven nebulization on the dynamic changes of partial pressure of carbon dioxide （PtCO₂）， pulse oxygen saturation （SpO₂）， and heart rate during nebulization， as well as the therapeutic effects in patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods A total of 99 patients with acute exacerbation of COPD requiring non-invasive mechanical ventilation and nebulization were randomly divided into a control group， an experimental group one， and an experimental group two， with 33 patients in each group. The control group was given non-invasive intermittent oxygen-driven nebulization， the experimental group one was given non-invasive intermittent air-driven nebulization， and the experimental group two was given non-invasive simultaneous air-driven nebulization. The changes in PtCO₂， SpO₂， and heart rate at 0 min， 5 min， 10 min， 15 min during nebulization， 5 min， 10 min， and 15 min after nebulization were recorded. The values of arterial blood gas PaCO₂ and PaO₂ were recorded every morning from before treatment to the 7th day of treatment. The length of hospital stay in the three groups was also recorded. Results The comparison of PtCO₂ during nebulization among the three groups showed that there were statistically significant differences in the main effect of time and the interaction effect of time and group （P < 0.001）. The PtCO₂ values in the control group showed a linear relationship with time （F = 10.166， P = 0.003）， increasing over time； the PtCO₂ values in the experimental group one showed a linear relationship with time （F =10.544， P = 0.003）， decreasing over time； the PtCO₂ values in the experimental group two showed a linear relationship with time （F = 20.003， P < 0.001）， decreasing over time. A one-way ANOVA was conducted on the PtCO₂ values at each time point in the three groups. The PtCO₂ value at 15 min of nebulization in the control group was higher than that in the experimental group one and the experimental group two. There were statistically significant differences in the difference in PtCO₂ before and after nebulization （dPtCO₂） between the experimental group one and the experimental group two and the control group （P<0.05）. A one-way ANOVA was conducted on the PtCO₂ values at each time point during the observation period after nebulization. The results showed that there were statistically significant differences in PtCO₂ at 0 min and 5 min after nebulization among the three groups （P < 0.05）， while there were no statistically significant differences in PtCO₂ at 10 min and 15 min after nebulization among the three groups （P > 0.05）. The comparison of SPO₂ during nebulization among the three groups showed that there were statistically significant differences in the interaction effect of time and group （P < 0.05）. The SPO₂ values in the experimental group one decreased over time. The SPO₂ values at 10 min and 15 min of nebulization in the control group were higher than those in the experimental group one and the experimental group two. All three groups could improve PaCO₂ in arterial blood gas with the treatment days （P<0.05）. Conclusions All three nebulization treatment methods can achieve good therapeutic effects. However， non-invasive intermittent oxygen-driven nebulization can increase PtCO₂ and SPO₂ during nebulization； non-invasive intermittent air-driven nebulization can decrease PtCO₂ and SPO₂ during nebulization； non-invasive simultaneous air-driven nebulization can decrease PtCO₂ and maintain stable SPO₂ during nebulization. Therefore， non-invasive simultaneous air-driven nebulization is a relatively safer nebulization inhalation method and is worthy of clinical promotion.

Objective To investigate the risk factors associated with postoperative pulmonary infection after pancreaticoduodenectomy （PD） and construct a predictive model for guiding early clinical intervention. Methods A retrospective analysis was carried out on 220 patients who underwent PD at the First Affiliated Hospital of Xinjiang Medical University between January 2022 and October 2024. Cases with preoperative pulmonary infection， incomplete data， or perioperative mortality were excluded. Preoperative， intraoperative， and postoperative clinical data were meticulously collected. Univariate analysis was employed to screen potential risk factors， and multivariate logistic regression was utilized to identify independent risk factors. Subsequently， a nomogram prediction model was constructed. Results Pulmonary infection occurred in 84 patients （38.2%） following surgery. Multivariate analysis indicated that a high body mass index （BMI） （OR = 1.12， 95%CI： 1.02 ~ 1.23， P < 0.05）， low albumin levels on postoperative day 3 （OR = 0.91， 95% CI： 0.83 ~ 0.99， P < 0.05）， an extended retention time of the postoperative abdominal drainage tube （OR = 1.05， 95% CI： 1.01 ~ 1.09， P < 0.05）， a prolonged postoperative bed rest duration （OR = 1.56， 95% CI： 1.22 ~ 1.99， P < 0.05）， and the occurrence of non?pulmonary complications （OR = 2.23， 95% CI： 1.05 ~ 4.75， P < 0.05） were independent risk factors for pulmonary infection. The prediction model attained an area under the receiver operating characteristic curve （AUC） of 0.82 （95% CI： 0.76 ~ 0.88）， with the calibration curve showing a good fit. After internal validation， the AUC remained stable at 0.80 （95% CI： 0.71 ~ 0.88）， validating the robust predictive ability of the model. Conclusions Elevated BMI， low postoperative albumin levels， extended retention time of the abdominal drainage tube， prolonged duration of bed rest， and non?pulmonary complications are identified as independent risk factors for pulmonary infection following PD. The established risk prediction model demonstrates robust predictive capabilities， thereby furnishing a foundation for individualized risk assessment and targeted preventive strategies.

Objective To assess the efficacy and the survival rate of the hip joint following the treatment of osteonecrosis of the femoral head （ONFH） with ultrasound?guided percutaneous intra?articular platelet?rich plasma （PRP） injection in combination with percutaneous silver needle thermalolysis. Methods Fifty?six patients diagnosed with ARCO （Association Research Circulation Osseous） stage Ⅱ ONFH were randomly allocated into two groups. The first group， designated as the PRP injection combined with silver needle thermalolysis group （Group R， n = 28）， and the second group， the steroid injection combined with silver needle thermalolysis group （Group S， n = 28）. Both groups underwent three injections （administered at 4?week intervals） and one session of silver needle thermalolysis. Outcome measures， including the Numerical Rating Scale （NRS） for pain assessment， Harris Hip Score （HHS）， daily consumption of non?steroidal anti?inflammatory drugs （etoricoxib） and tramadol， progression to ARCO stage Ⅲ， and the rates of surgical intervention， were recorded at baseline， 3 days， and 1， 3， 6， and 12 months after the treatment. Results When compared to the baseline， both groups manifested significant decreases in NRS scores and enhancements in HHS at all follow?up time points （P < 0.05）. Specifically， Group R demonstrated more favorable outcomes compared to Group S. At 3， 6， and 12 months， Group R had lower NRS scores （P < 0.01） and more notable improvements in HHS （P < 0.01）. Additionally， the daily analgesic consumption （etoricoxib and tramadol） in Group R was significantly lower than that in Group S at 3， 6， and 12 months （P < 0.01）. Moreover， Group R exhibited a significantly lower progression rate to ARCO stage III and a lower hip replacement surgery rate （P < 0.05）. Conclusions Ultrasound?guided intra?articular PRP injection in combination with silver needle thermalolysis expedites pain alleviation， enhances hip function， reduces analgesic dependence， and retards the progression of ONFH. This approach thus represents a clinically viable option for early?stage intervention.

Objective To investigate the influence of combination of oxycodone-acetaminophen and local radiotherapy on serum cytokines in elderly patients with malignant tumor bone metastasis and cancer pain. Methods Eighty elderly patients with malignant tumor bone metastasis and cancer pain admitted to Huainan Xinhua Medical Group Xinhua Hospital from January 2020 to April 2024 were divided into control group （40 cases） and observation group （40 cases） according to the order of admission. The control group received codeine combined with local radiotherapy， whereas the observation group was treated with oxycodone-acetaminophen combined with local radiotherapy. Pain relief （assessed using visual analogue scale （VAS））， daily fulminant pain occurrence frequency and occurrence of adverse reactions during treatment as well as serum cytokines ［substance P （SP）， prostaglandinE2 （PGE2）， interleukin-6 （IL-6）］， sleep quality （assessed using Pittsburgh sleep quality index （PSQI）） and quality of life ［assessed using functional assessment of cancer therapy-general （FACT-G）］ before and after treatment were compared between the two groups.. Results The pain relief effect in the observation group was better （P < 0.05）， and the daily occurrence frequency of fulminant pain was less than that in the control group （P < 0.05）. After treatment， serum levels of SP， PGE2 and IL-6 in the observation group were lower compared to those in the control group （P < 0.05）. The total incidence rate of bone-related events during treatment was not significantly different between the two groups （P > 0.05）， and the total incidence rate of adverse reactions was lower in the observation group compared to those in the control group （P < 0.05）. The PSQI score in the observation group after treatment was lower （P < 0.05） while the scores of physiology and emotion of FACT-G were higher compared to those in the control group （P < 0.05）. Conclusion Oxycodone-acetaminophen combined with local radiotherapy can down-regulate the levels of serum SP， PGE2 and IL-6， relieve the pain， and improve the sleep quality and quality of life in elderly patients with malignant tumor bone metastasis complicated with cancer pain.

Objective To comparatively evaluate the clinical efficacy of liposomal bupivacaine and ropivacaine in transversus abdominis plane （TAP） block combined with intravenous patient?controlled analgesia （PCA） following cesarean section， and to explore the analgesic advantages of liposomal bupivacaine. Methods Eighty parturients scheduled for elective cesarean section were recruited and randomly allocated into two groups via a random number table： the liposomal bupivacaine group and the ropivacaine group. At the conclusion of the surgical procedure， both groups underwent ultrasound?guided bilateral TAP block. In the ropivacaine group， 20 mL of 0.5% ropivacaine was administered per side. In the liposomal bupivacaine group， 266 mg of liposomal bupivacaine was dissolved in 0.9% normal saline to a total volume of 40 mL， with 20 mL injected per side. The following parameters were compared between the two groups： Visual Analog Scale （VAS） scores at rest and during movement at various postoperative time points， the overall scores of the 15?item Quality of Recovery （QoR?15） scale， postoperative opioid consumption， the time to first ambulation， the time to first flatus， and the incidence of adverse drug reactions such as nausea， vomiting， constipation， and pruritus. Results In comparison with the ropivacaine group， the liposomal bupivacaine group exhibited significantly lower Visual Analogue Scale （VAS） scores both at rest and during movement at 12 hours， 24 hours， and 48 hours postoperatively （P < 0.001）. Significantly higher Quality of Recovery?15 （QoR?15） scores were recorded in the liposomal bupivacaine group at 24 hours and during the 24? 48? hour period postoperatively （P < 0.001）. The postoperative opioid consumption within 48 hours was markedly lower in the liposomal bupivacaine group （P < 0.001）. The time to first flatus was significantly shorter in the liposomal bupivacaine group （P < 0.001）. No significant differences were detected in the incidence of nausea， vomiting， or constipation between the two groups （P > 0.05）， and no cases of pruritus or other severe adverse reactions were observed. Conclusion Liposomal bupivacaine used for TAP block following cesarean section offers extended analgesia， reduces the need for opioids， enhances the quality of postoperative recovery， promotes gastrointestinal motility， and demonstrates excellent safety.

Objective To detect the content of 5'-tRF-GlyGCC in peripheral blood and explore its application value in the early diagnosis of colorectal cancer （CRC）. Methods Peripheral blood samples were randomly collected from 99 CRC patients， 11 patients with enteritis， 17 patients with colorectal polyps and 99 healthy individuals in the same period at the Affiliated Hospital of Guizhou Medical University. The content of 5'-tRF-GlyGCC in total RNA of peripheral blood was detected by fluorescence RT-PCR. The receiver operating characteristic curve （ROC） was established to analyze the value of 5'-tRF-GlyGCCcontent in the early diagnosis of CRC and to explore the relationship between its content and the clinical and pathological characteristics of CRC patients. Results The content of 5'-tRF-GlyGCC in the peripheral blood of CRC patients and colorectal polyp patients was significantly higher than that of healthy individuals and patients with enteritis， and the differences were statistically significant （P < 0.05）. The area under the curve （AUC） of 5'-tRF-GlyGCC for diagnosing CRC was 0.817 （95%CI： 0.763 ~ 0.871）， with a diagnostic sensitivity of 56.7% and a specificity of 99.9%. The content of 5'-tRF-GlyGCC in peripheral blood was significantly positively correlated with the levels of CEA and CA19-9 in CRC patients. Conclusion The detection of 5'-tRF-GlyGCC in peripheral blood has a high application value in the early diagnosis of CRC and can be used for clinical reference and research.

Objective To investigate the combined value of multimodal functional magnetic resonance imaging （fMRI） and magnetic resonance spectroscopy （MRS） in the differential diagnosis of postoperative recurrence and pseudoprogression （PsP） of glioma. Methods One hundred and four patients with glioma confirmed by surgical pathology were selected from our hospital from September 2021 to March 2024， and the patients were divided into recurrence group （n = 70） and PsP group （n = 34） according to the revised glioma treatment response assessment criteria. Another group of 73 patients with glioma were selected for model validation. The general data， apparent diffusion coefficient （ADC） of multimodal fMRI parameters， standardized cerebral blood volume （CBV） and MRS indexes of the two groups were compared. The influencing factors of postoperative glioma recurrence were analyzed by logistic regression， and clinical efficacy of the combined treatment in the diagnosis of postoperative glioma recurrence and PsP was analyzed by receiver operating curve （ROC）. Results The level of ADC in the recurrence group was lower than that in the PsP group （P < 0.05）， and the levels of CBV， choline （Cho）/creatine （Cr） and Cho/ N-acetylaspartic acid （NAA）were higher （P < 0.05）. Logistic regression analysis showed that the levels of ADC， CBV， Cho/Cr and Cho/NAA were risk factors for postoperative recurrence of glioma （P < 0.05）. ROC showed that the combined use of multimodal fMRI and MRS in the differential diagnosis of postoperative glioma recurrence and PsP had an AUC of 0.916， outperforming the diagnostic accuracy of each individual modality. Validation of the combined model constructed with multimodal fMRI and MRS yielded an AUC of 0.929， 95% CI （0.844 ~ 0.976）， with a sensitivity of 88.46% and specificity of 91.49%. There was no statistical difference when compared to the AUC of the combined predictive model established in the earlier phase. Conclusion Multi-mode fMRI combined with MRS demonstrate high clinical value in the differential diagnosis of postoperative glioma recurrence and PsP， and it is worth to be popularized.

Objective This study examines serum lipid metabolism characteristics in colorectal cancer patients and its diagnostic potential. Methods Serum samples from 57 colorectal cancer patients and 54 healthy controls underwent lipidomic analysis using ultra-high performance liquid chromatography-time-of-flight mass spectrometry， combined with principal component analysis （PCA） and orthogonal partial least squares discriminant analysis （OPLS-DA） . Differential lipids were identified based on criteria of P< 0.05， VIP > 1， and fold change < 0.67 or > 1.5. These lipids were further evaluated using receiver operating characteristic （ROC） analysis to identify biomarkers with strong diagnostic value. Results Five classes and 66 differential lipids were identified， with phosphatidylcholine （PC） and triglyceride （TG） comprising 59.09%. KEGG pathway enrichment indicated involvement in glycerophospholipid and glycerol ester metabolism pathways. ROC analysis identified Sphinganine， MG（19∶0）， LysoPC（18∶2）， PA（42∶6）， PC（36∶5）， PC（36∶4）， PC（38∶6）， and PC（40∶8） as having areas under the curve greater than 0.85. Conclusion The lipid metabolic profile of colorectal cancer （CRC） patients can be systematically analyzed through the efficient enrichment of lipid metabolites in serum using the UPLC-Q/TOF-MS technique， in conjunction with a modified Bligh-Dyer method. The identification of eight specific lipids including Sphinganine， MG（19∶0）， LysoPC（18∶2）， PA（42∶6）， PC（36∶5）， PC（36∶4）， PC（38∶6）， and PC（40∶8） offer novel insights and parameters for differentiating between healthy individuals and those diagnosed with colorectal cancer.

Rho GTPase-activating proteins （ARHGAP） constitute a family of multifunctional regulatory proteins that negatively regulate Rho family GTPases （e.g.， RhoA， Rac1， Cdc42） by accelerating the hydrolysis bound to these enzymes. Members of this family are extensively involved in crucial biological processes such as cellular signal transduction， adhesion， and dynamic reorganization of cytoskeleton， while also playing significant roles in tumor progression. ARHGAP expression and function vary across cancer types， with identical molecule exhibiting divergent expression levels and biological effects in various malignancies. The regulatory effects of ARHGAP family members on tumor cell migration are closely associated with their unique structural domain characteristics and are modulated by multiple signaling pathways. This paper comprehensively analyzes and summarizes existing research to explore the roles and mechanisms of ARHGAP family members in tumor cell migration， aiming to identify potential biomarkers and therapeutic targets in cancer management and prevention.

Allergic diseases represent a significant global health challenge， and allergen-specific immunotherapy （AIT）， as a first-line treatment， is the only therapeutic approach capable of altering the natural course of these diseases. This article provides a systematic review of the major advancements in AIT over recent years， encompassing novel routes of administration， the integration of biologics and adjuvants， advancements in allergen preparation， strategies for adverse reaction prevention and management， and efficacy evaluation methods. Among the new routes of administration， intratympanic， intratonsillar， epicutaneous， and intranasal immunotherapies have demonstrated safety， efficacy， and enhanced patient adherence. Biologics such as omalizumab， dupilumab， and Tezepelumab， each with distinct anti-allergic mechanisms， reduce adverse reactions and optimize outcomes when combined with AIT. The use of adjuvants represents another strategy to enhance AIT efficacy； agents like β-glucans， mannan， CpG oligodeoxynucleotides （CpG-ODN）， liposomes， and nanoparticles stimulate immune responses， promote immune tolerance， and improve the therapeutic effects of AIT. Recombinant allergens， produced through genetic engineering， offer high purity and consistency， providing more reliable and reproducible therapeutic results for AIT. In summary， this review highlights the latest developments in various approaches aimed at enhancing AIT efficacy， offering new insights into the treatment of allergic diseases.