To understand the clinical practice of epidermal growth factor receptor tyrosine kinase inhibitor （EGFR TKI） therapy alone and in combination with chemotherapy or antiangiogenic therapy in the real-world setting for patients with advanced EGFR-mutant NSCLC， and to explore the difference in efficacy between the two treatment regimens.
Methods
Between January 1， 2018 and March 31， 2024， patients with advanced EGFR-mutant NSCLC were identified at the Department of Respiratory and Critical Care Medicine of Peking University Shougang Hospital. Subgroups were analysed according to the use of different generations of EGFR TKIs for first-line treatment and whether or not using monotherapy. Clinical and pathological characteristics were analysed， and the efficacy results of the different treatment subgroups were also investigated.
Results
Sixty-six patients with advanced EGFRmutated NSCLC were enrolled， including 34 in the monotherapy group （1st generation EGFR TKIs： 20； 2nd generation EGFR TKIs：3； and 3rd generation EGFR TKIs： 11） and 32 in the combination therapy group （1st generation EGFR TKIs： 15； 2nd generation EGFR TKIs： 4； and 3rd generation EGFR TKIs： 13）. Univariate analysis demonstrated that smoking history and chronic obstructive pulmonary disease （COPD） were factors influencing the choice of combination therapy （P=0.022 and P=0.044）. The combination therapy group had higher real-world objective response rate （rwORR） and median real-world progression free survival （rwPFS）values than the monotherapy group in the overall population and subgroups using different generations of EGFR TKI subgroups， but none of these differences were statistically significant （P＞0.05）. In terms of overall survival， there was no statistically significant difference between the monotherapy and combination therapy groups in the overall population， as well as in the 1st generation and 3rd generation EGFR TKI groups （P＞0.05）. However， a statistically significant difference was observed in the 2nd generation EGFR TKI subgroup with a limited sample size （P＜0.05）.
Conclusion
History of smoking and COPD are factors influencing the choice of combination regimen. There is a trend towards benefit in rwORR and rwPFS with combination therapy compared to monotherapy， suggesting that combination therapy could be a superior firstline treatment option for some patients with advanced EGFR-mutated NSCLC.
To compare the effect of left bundle branch pacing versus right ventricular pacing on tricuspid regurgitation.
Methods
This study included 93 patients who underwent pacemaker implantation at Peking University International Hospital from 2018 to 2023. The patients were divided into a left bundle branch pacing group （45 cases） and a right ventricular pacing group （48 cases）.Tricuspid regurgitation severity， cardiac structural parameters， and cardiac function were assessed using echocardiography， and preoperative and postoperative differences were compared between the two groups.
Results
There was no significant difference in tricuspid regurgitation between the left bundle branch pacing group and right ventricular pacing group both before and after implantation （P=0.27， P=0.55）.Subsequently， subgroup analyses were performed based on the presence of atrial fibrillation and moderate to severe tricuspid regurgitation before implantation. In the atrial fibrillation subgroup， tricuspid regurgitation significantly improved after left bundle branch pacing （P=0.02）， while there was no significant improvement in the right ventricular pacing group. In the subgroup with moderate to severe tricuspid regurgitation， the grade of tricuspid regurgitation significantly improved after left bundle branch pacing （P＜0.01）， and the velocity of tricuspid regurgitation also showed improvement （P=0.04）； however， no significant differences were observed in the right ventricular pacing group.
Conclusion
Left bundle branch pacing may have potential advantages in reducing tricuspid regurgitation. Compared to right ventricular pacing， left bundle branch pacing significantly alleviates tricuspid regurgitation in patients with atrial fibrillation and pre-existing moderate to severe tricuspid regurgitation.
To evaluate the efficacy and safety of cefdinil dispersible tablets combined with minimally invasive rotatectomy in the treatment of plasma cell mastitis （PCM）.
Methods
A total of 86 patients with PCM admitted to Civil Aviation General Hospital from August 2023 to May 2024 were randomly divided into a conventional treatment group （n=28， treated by incision and drainage）， a control group （n=29， treated with cefdinir dispersible tablets combined with incision and drainage）， and a combination treatment group （n=29， treated with cefdinir dispersible tablets combined with minimally invasive rotatectomy）. Operation related indexes， levels of inflammatory factors， immunoglobulins （Igs），and complications were compared among the three groups.
Results
The operation related indexes in the combination treatment group were lower than those of the conventional treatment group and control group（P＜0.05）. After intervention， the levels of interleukin-6 （IL-6）， interleukin-1α （IL-1α）， and tumor necrosis factor-α （TNF-α）， as well as the levels of IgG， IgM， and IgA， in the combination treatment group were lower than those of the conventional treatment group and control group （P＜0.05）， The total incidence of complications in the combination group was 3.45% （1/29）， which was lower than that of the conventional treatment group （13.95% （8/28） and control group （20.69%）， and there was a statistical difference among the three groups （P＜0.05）.
Conclusion
Cefdinil dispersible tablets combined with minimally invasive rotatectomy in the treatment of PCM have significant therapeutic effects and high safety， which can shorten the operation time， reduce the intraoperative blood loss， decrease the incision healing time and incision length，improve the levels of inflammatory factors and Igs， and reduce the incidence of complications.
To evaluate the effectiveness of the Difficult Airway PHysiological Score（DAPS） in predicting physiologically difficult airways and associated adverse outcomes in the emergency medicine department.
Methods
This retrospective， single-center study was conducted using data from the Department of Emergency Medicine of Hebei University Affiliated Hospital from 2023 to 2024. A total of 271 eligible adult intubation patients were included and divided into a high-risk group （DAPS≥10） and a lowrisk group （DAPS＜10） based on their DAPS scores. Primary outcomes included the incidence of adverse events such as hypotension， hypoxemia， cardiac arrest， and death within 1 hour post-intubation. Statistical analyses included t-tests， chi-square tests， and receiver operating characteristic （ROC） curve analysis.
Results
Of the 271 patients， 62.4% were male， and 60.6% were aged ≥45 years. Respiratory distress and coma were the main reasons for intubation， accounting for 75.3% and 66.4% of cases， respectively. The incidence of adverse events was significantly higher in the high-risk group than in the low-risk group， including hypotension （51.6% vs 16.4%）， hypoxemia （31.4% vs 14.3%）， cardiac arrest （23.3% vs 8%）， and death within 1 hour post-intubation （32.1% vs 15.2%） （all P＜0.001）. The area under the ROC curve for DAPS was 0.813，demonstrating good predictive performance.
Conclusion
DAPS is an effective tool for early identification of patients with physiologically difficult airways and associated adverse outcomes in the emergency medicine department， aiding clinicians in risk stratification and management.
To evaluate the clinical efficacy and safety of dupilumab combined with Yupingfeng granules in the treatment of moderate to severe atopic dermatitis in children.
Methods
A total of 76 children with moderate to severe atopic dermatitis who were treated in the Affiliated Huai'an Hospital of Xuzhou Medial University from January 2023 to December 2023 were selected as the study sample，and they were divided into a control group （n=38） and a treatment group （n=38） using the random number table method. The control group was only given dupilumab injection treatment， and the treatment group was treated with dupilumab injection combined with Yupingfeng granules. Clinical efficacy and changes in EASI， SCORAD， IGA， and CDLQI scores of the two groups were compared. Eosinophils （EOS） and IgE levels and the incidence of adverse reactions were monitored. In addition， the two groups were followed for 6 months to compare the recurrence.
Results
The total effective rate in the treatment group was higher than that of control group （P＜0.05）. After treatment， EASI， SCORAD， IGA， and CDLQI scores in both groups were significantly decreased compared with those before treatment （P＜0.05）， and the scores in the treatment group were significantly lower than those of the control group. EOS and IgE levels were also significantly decreased after treatment （P＜0.05）， and the reduction was more obvious in the treatment group （P＜0.05）.No significant difference was observed in the incidence of adverse reactions between the two groups during treatment （P＞0.05）. After 6 months of follow-up， the recurrence rate in the treatment group was significantly lower than that of control group （P＜0.05）.
Conclusion
Dupilumab injection combined with Yupingfeng granules can significantly improve the efficacy， reduce EOS and IgE levels， have a good safety， and reduce recurrence in the treatment of moderate to severe atopic dermatitis in children.
To examine the influence of nutritional factors on the prediction of acute toxicities in elderly patients with esophageal cancer undergoing radiotherapy or concurrent chemoradiotherapy.
Methods
A cohort of 101 esophageal cancer patients who received radiotherapy or concurrent chemoradiotherapy at Bozhou People's Hospital between 2017 and 2024 was included in this investigation. The impact of pre-treatment nutritional indicators， including body mass index （BMI）， albumin（ALB）， prealbumin （PA）， hemoglobin （Hb）， Nutritional Risk Index （NRI）， Nutritional Risk Screening 2002（NRS2002）， and total lymphocyte count （TLC）， on acute toxicities during radiotherapy and concurrent chemoradiotherapy was investigated. Univariate analysis was performed utilizing the chi-square test， and multivariate analysis was conducted using logistic regression.
Results
In this patient cohort， the prevalence of malnutrition， as determined by various nutritional indicators， ranged from 8% to 56%. The incidence rates of hematologic acute toxicities were 83.2% for grades 0～2 and 16.8% for grades 3～4. Similarly， the incidence rates of non-hematologic acute toxicities were 86.1% for grades 0～2 and 13.9% for grades 3～4.Multivariate analysis identified Hb and TLC as independent predictors of hematologic acute toxicities（P=0.013 and P=0.020， respectively）. Furthermore， ALB was identified as an independent predictor of nonhematologic acute toxicities （P=0.029）. In contrast， neither the NRS2002 nor BMI demonstrated a significant association with acute toxicities in elderly esophageal cancer patients undergoing radiotherapy and concurrent chemoradiotherapy.
Conclusion
These findings suggest that nutritional indicators in this patient population are significantly correlated with chemoradiotherapy-related toxicities. Therefore， proactive nutritional support and management in clinical practice may potentially mitigate the adverse effects associated with chemoradiotherapy.
To identify the predictors of clinical efficacy of the tumour necrosis factoralpha （TNF-α） inhibitor adalimumab in the treatment of patients with rheumatoid arthritis （RA）.
Methods
A retrospective study was conducted on 216 RA patients treated with adalimumab who visited Jiangsu Province（Suqian） Hospital from January 2018 to December 2023， including 148 with response and 68 with no response to the therapy. Correlation analysis of the effectiveness of adalimumab in the treatment of RA was carried out using the point biserial correlation test and Spearman's Rho test. The predictors of efficacy of adalimumab for RA were identified using binary logistic regression analysis， and the predictive value of the predictors was assessed by receiver operating characteristic （ROC） curve analysis.
Results
The proportion of women（χ2=48.430， P＜0.001）， DAS28 （t=6.827， P＜0.001）， tumour necrosis factor-alpha （TNF-α） （t=3.719，P＜0.001）， and interferon-alpha （IFN-α） （t=5.22， P＜0.001） were higher in the response group than in the non-response group， while the non-response group had a higher proportion of patients with osteoporosis（χ2=56.263， P＜0.001） and glucocorticoid use （χ2=93.122， P＜0.001）. DAS28 （r=0.423， P＜0.001），TNF-α （r=0.171， P=0.012）， and IFN-α （r=0.237， P＜0.001） were positively associated with clinical effectiveness， whereas men （r=-0.427， P＜0.001）， osteoporosis （r=-0.510， P＜0.001）， and glucocorticoid therapy（r=-0.657， P＜0.001） were negatively associated with clinical effectiveness. The results of regression analyses showed that being female ［OR （95%CI）=0.001 （0， 0.067， P＜0.001］， no osteoporosis ［OR （95%CI）=0（0， 0.049）， P=0.003］， high DAS28 ［OR （95%CI）=83.455 （5.225， 1332.91）， P=0.002］， high IFN-α ［OR（95%CI） =10.259 （2.28， 46.164）， P=0.002］， and no glucocorticoid treatment ［OR （95%CI）=0.019 （0.001，0.366） P=0.019］ may be predictive factors for patients with RA responding to adalimumab treatment. With a cutoff value of 3.665， DAS28 had an area under the curve （AUC） value of 0.724 for the prediction of treatment response， with a sensitivity of 44.12% and specificity of 98.65%. With a cutoff value of 3.750，IFN-α had an AUC value of 0.780 for the prediction of treatment response， with a 97.06% sensitivity and 57.82% specificity. The AUC for the combined DAS28 and IFN-α was 0.898， and the sensitivity and specificity were 93.75% and 73.44%， respectively.
Conclusion
Female gender， no osteoporosis， high DAS28， high IFN-α， and no glucocorticoid treatment may be predictors of RA patients responding to adalimumab treatment. Among them， DAS28 is a more specific predictor， IFN-α is a more sensitive predictor，and the combination of the two has greater predictive value.
To investigate the effects of galactooligosaccharides （GOS） on bone metabolism in ovariectomized mice and the underlying mechanisms.
Methods
Eighteen C57BL/6J mice were randomly assigned to three groups： sham operation group （Sham）， ovariectomy-induced postmenopausal osteoporosis model group （OVX）， and treatment group （GOS）. Micro-CT was used to assess femoral microstructure， immunohistochemistry to evaluate osteogenesis and osteoclastogenesis， ELISA to measure serum levels of osteogenic and osteoclastic markers， 16S rRNA sequencing to analyze gut microbiota composition， H&E staining to examine intestinal barrier integrity， and Western blot and qPCR to detect expression levels of tight junction proteins and inflammatory factors.
Results
Compared with the Sham group， the bone mass in the OVX group was significantly reduced. In contrast， the GOS intervention group exhibited significant improvements in bone mass-related parameters （P＜0.01）. The OVX group showed reduced alkaline phosphatase （ALP） staining and increased tartrate-resistant acid phosphatase （TRAP）levels； GOS treatment significantly increased ALP and inhibited TRAP （P＜0.01）. Serum osteocalcin levels decreased while type I collagen C-terminal peptide levels increased in the OVX group； GOS treatment reversed these trends （P＜0.01）. 16S rRNA sequencing revealed that OVX reduced gut microbial diversity，whereas GOS reshaped the gut microbiota and increased the abundance of beneficial bacteria. H&E staining revealed that the OVX group exhibited impaired colonic intestinal barrier integrity， whereas GOS treatment significantly restored the intestinal structure. Western blot and qPCR analyses demonstrated that in the OVX group， the expression levels of tight junction proteins Claudin-1 and ZO-1 were downregulated， while the levels of the inflammatory cytokines TNF-α and IL-1β were upregulated. In contrast， GOS treatment increased the expression of Claudin-1 and ZO-1 and decreased the expression of TNF-α and IL-1β （P＜0.01）.
Conclusion
GOS mitigate bone loss in OVX mice by reshaping the intestinal microbiota and strengthening the intestinal barrier function.
To develop a prognostic model for head and neck squamous cell carcinoma（HNSCC） utilizing immune and metabolic-related genes， and to assess its efficacy in predicting the prognosis of HNSCC patients.
Methods
The HNSCC patient dataset was obtained from the TCGA database， while the GSE65858 dataset was sourced from the GEO database. Additionally， immune and metabolic-related gene sets were acquired from the IMMPORT and MsigDB databases， respectively. Subsequently， the TCGA dataset was partitioned into a training cohort and a validation cohort. Univariate and multifactor Cox regression，along with LASSO regression， were employed to develop prognostic models for immune-related gene signatures （IMRGs） in the training cohort. Tissue expression of prognostic genes was detected by qPCR.Internal validation was carried out in the TCGA validation cohort， followed by external validation in the GSE65858 dataset. Immune infiltration analysis， Gene Set Enrichment Analysis （GSEA） pathway enrichment analysis， and tumor mutation load analysis were conducted to delineate pathway mechanism disparities between high and low-risk subgroups.
Results
Utilizing TCGA training set data， a prognostic model for head and neck squamous cell carcinoma was developed， comprising 10 genes （HLA-F， SLC11A1， GNRH1，LGR5， ICOS， and HPRT1 were highly expressed， while DES， BTC， DDO， and CDO1 were lowly expressed in tumor tissues）. The survival duration of the low-risk subgroup significantly exceeded that of the high-risk group. Both univariate and multivariate COX analyses confirmed the risk score as an independent prognostic determinant. The combination of a risk score and various clinical features proves effective in predicting patient prognosis， as evidenced by an area under the receiver operating curve of 0.825 and a C-index of 0.751.GSEA enrichment and immune cell infiltration analyses revealed elevated B cell expression in the low-risk group. Moreover， gene correlation and tumor mutation load analyses indicated heightened levels of DNA replicators （MCM6 and POLD3）， mismatch repair gene （MSH6）， epithelial mesenchymal transformation gene （LOXL2）， and tumor mutation rate in the high-risk group.
Conclusion
The IMRGs model for HNSCC patients constructed based on 10 genes can effectively predict the prognosis of patients， and provide a new target for clinical prognosis identification and treatment.
Atrial fibrillation （AF） is one of the most common arrhythmias in adults. Unexplained embolic stroke （ESUS） is defined as an ischemic stroke in which no clear cause has been identified despite recommended etiological testing. Ruling out atrial fibrillation is an extremely important step in the diagnosis of ESUS. However， there is no clear description in the current guidelines for the monitoring equipment used to rule out atrial fibrillation， the duration of monitoring， the various predictors of atrial fibrillation， and the personalized monitoring of different atrial fibrillation risk groups.
Chronic kidney disease-mineral and bone disorder （CKD-MBD） and sarcopenia are common complications of end-stage renal disease. The main characteristics of sarcopenia are reduced muscle mass and reduced strength. Recent studies have suggested that CKD-MBD may increase the incidence of sarcopenia. However， the relationship between CKD-MBD and sarcopenia is not clear. Tle reviews the research on the impact of CKD-MBD on sarcopenia in patients.
Myxoma is one of the most common primary heart tumors and is the focus of echocardiography teaching. Because it is difficult to find a suitable myxoma model in traditional teaching models or porcine heart dissection， and the treatment methods for myxoma and thrombosis are completely different， it is difficult to teach the diagnosis and differential diagnosis of myxoma. The hand-and-foot teaching method is to apply simple body language and props to the clinical teaching process， so that medical knowledge can be simplified and concrete， which can stimulate students' interest and improve teaching effect.This paper reports our experience in ultrasonic teaching using the hand-and-foot teaching method to help improve the diagnosis and differential diagnosis of myxoma.
