Lung cancer is one of the most common malignancies with the highest morbidity and mortality worldwide. Immune checkpoint inhibitors (ICIs) have significantly improved the prognosis of patients with advanced lung cancer, but more than half of patients derive limited benefit. The gut microbiota can regulate tumor immunity and ICIs efficacy via the gut-lung axis. Although accounting for a small proportion, the gut mycobiome exerts key immunomodulatory effects, yet relevant research lags far behind that of bacteria. This review systematically summarizes the clinical association between the gut mycobiome and lung cancer, clarifies the potential mechanisms by which the mycobiome and its metabolites influence ICIs efficacy through immune regulation, metabolic modulation, and cross-kingdom interactions, and summarizes potential strategies including dietary intervention, fecal microbiota transplantation, and fungal targeting. It provides theoretical support for establishing mycobiome-based predictive models, developing precise interventions, and improving the efficacy of ICIs.
. 【中文题目：肠道真菌组在肺癌免疫治疗中的作用：
机制、挑战与转化前景】 【中文摘要：肺癌是全球发病率与死亡率最高的恶性肿瘤之一，免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）显著改善晚期患者预后，但超半数患者获益有限。肠道微生物可通过肠-肺轴调控肿瘤免疫与ICIs疗效，肠道真菌组占比微小却具备关键免疫调控作用，相关研究远滞后于细菌。本文系统梳理肠道真菌组与肺癌的临床关联，阐明真菌组及其代谢物通过免疫调控、代谢调节及跨界互作影响ICIs疗效的潜在机制，总结饮食干预、粪便微生物移植、靶向真菌等潜在策略，为建立真菌组预测模型、开发精准干预手段、提升ICIs疗效提供理论支撑。
】 【中文关键词：肠-肺轴；肺肿瘤；肠道真菌；免疫检查点抑制剂；生物标志物】.
To evaluate the clinical efficacy and safety of the 3-month formulation of triptorelin (triptorelin pamoate) in the treatment of idiopathic central precocious puberty (ICPP) in children. A retrospective analysis was conducted of 49 children with ICPP treated with the 3-month formulation of triptorelin at Xiangya Hospital, Central South University, from May 2023 to September 2025. All patients received at least one injection and completed a 3-month follow-up. The numbers of patients who subsequently completed 6-, 9-, and 12-month follow-ups were 42, 26, and 11, respectively. Sex hormone levels, growth and development, and the differences between bone age and chronological age (ΔBA-CA) were assessed at 3, 6, 9, and 12 months after treatment initiation. At diagnosis, after the gonadotropin-releasing hormone agonist stimulation test, the peak luteinizing hormone (LH) level was (15.6±5.8) IU/L, the peak follicle-stimulating hormone (FSH) level was (8.5±3.9) IU/L, and the peak LH/FSH ratio was 1.9±0.9. After 3 months of treatment, 92% of the children achieved a peak LH <3 IU/L, all children had a peak LH/FSH ratio <0.6, and estradiol or testosterone decreased to prepubertal levels; this suppression was maintained through 12 months without rebound. In girls, uterine length was significantly reduced from baseline at 3, 6, 9, and 12 months (P<0.0125). In boys, testicular volume was significantly reduced from baseline at each follow-up (P<0.0125). At 3, 6, 9, and 12 months, ΔBA-CA was significantly decreased compared with baseline in all children (P<0.0125). The incidence of adverse reactions during treatment was low, no treatment discontinuations due to adverse events occurred, and overall tolerability was good. The 3-month formulation of triptorelin effectively suppresses the hypothalamic-pituitary-gonadal axis and delays bone age progression in children with ICPP, providing the potential to improve adult height, with a favorable safety profile. 目的: 评估曲普瑞林3月剂型（双羟萘酸曲普瑞林）在儿童特发性中枢性性早熟（idiopathic central precocious puberty, ICPP）治疗中的临床疗效与安全性。方法: 回顾性分析2023年5月—2025年9月中南大学湘雅医院诊治的49例接受曲普瑞林3月剂型治疗的ICPP患儿的临床资料。所有患儿均接受至少1次曲普瑞林3月剂型注射并完成3个月随访，后续完成6、9、12个月随访的例数分别为42例、26例和11例。分析治疗3、6、9、12个月后的性激素水平、生长发育情况及骨龄与实际年龄差值（differences between bone age and chronological age, ΔBA⁃CA）的变化。结果: 诊断时促性腺激素释放激素类似物激发试验后黄体生成素（luteinizing hormone, LH）峰值水平为（15.6±5.8）IU/L，卵泡刺激素（follicle⁃stimulating hormone, FSH）峰值水平为（8.5±3.9）IU/L，LH/FSH峰值比值为1.9±0.9。治疗3个月后，92%的患儿LH峰值<3 IU/L，所有患儿LH/FSH峰值比值<0.6，雌二醇或睾酮降至青春前期水平，且持续至12个月未见反弹。女性患儿治疗3、6、9、12个月后的子宫长度均较治疗前显著缩短（P<0.0125）;男性患儿的睾丸容积均较治疗前显著减少（P<0.0125）。治疗3、6、9、12个月后，所有患儿的ΔBA⁃CA与治疗前比较均显著减小（P<0.0125）。治疗期间不良反应发生率较低，患儿没有出现因不良事件导致的治疗中断，总体耐受性良好。结论: 曲普瑞林3月剂型治疗ICPP可有效抑制下丘脑-垂体-性腺轴，延缓骨龄进展，为改善成年身高提供可能，且安全性较高。.
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent upper airway collapse and apnea during sleep, resulting in intermittent hypoxia, oxidative stress, and systemic inflammation, and is closely associated with multisystem dysfunction, including cardiovascular disease, cognitive impairment, and metabolic abnormalities. Lung cancer remains one of the leading causes of cancer-related mortality worldwide and represents a major threat to human health. Recent studies suggest that OSA and lung cancer share several common risk factors, including smoking, older age, and obesity, and exhibit overlapping pathophysiological mechanisms, indicating that OSA may be involved in the initiation and progression of lung cancer. However, the epidemiological evidence regarding the association between OSA and lung cancer remains inconsistent, and the underlying molecular mechanisms as well as the clinical value of potential interventions have yet to be systematically elucidated. This review therefore summarizes the epidemiological characteristics, potential pathophysiological mechanisms, and therapeutic strategies related to the coexistence of OSA and lung cancer, with the aim of providing a theoretical basis for clinical decision-making and future mechanistic studies.
. 【中文题目：阻塞性睡眠呼吸暂停合并肺癌的研究进展】 【中文摘要：阻塞性睡眠呼吸暂停（obstructive sleep apnea, OSA）是临床常见的睡眠障碍性疾病，其典型特征为睡眠过程中反复发生的上气道塌陷与呼吸暂停现象，可引起间歇性低氧、氧化应激及全身炎症反应，并与心血管疾病、认知功能障碍及代谢异常等多系统功能损害密切相关。肺癌作为全球肿瘤相关死亡的主要原因之一，严重威胁患者的生命健康。近年来研究发现OSA与肺癌具有吸烟、高龄及肥胖等共同危险因素，且二者在病理生理机制上存在一定交叉性，提示OSA可能参与肺癌的发生发展过程。然而，目前关于OSA合并肺癌的流行病学证据仍不一致，其潜在分子机制及临床干预价值尚未得到系统阐明，相关研究仍存在一定不足。故本文拟从OSA合并肺癌的流行病学现状、可能的病理生理机制以及治疗策略等方面进行综述，以期为后续临床治疗决策以及机制研究提供理论依据及参考。
】 【中文关键词：阻塞性睡眠呼吸暂停；肺肿瘤；慢性间歇性低氧；病理生理机制；流行病学】.
The diagnosis of SMARCA4-altered pulmonary tumors primarily relies on the detection of protein loss by immunohistochemistry (IHC). However, the concordance between IHC and genetic testing results, as well as the clinical and biological differences caused by various mutation types, require further investigation. This study aimed to explore the clinicopathological, genomic characteristics, as well as the prognosis, of these tumors. A total of 18 consecutive cases of pulmonary tumor patients with SMARCA4 deficiency/mutation confirmed by IHC or genetic testing were retrospectively enrolled for clinical, genomic, and prognostic analysis. Based on the variant type, patients were categorized into Class 1 (protein loss or loss-of-function gene mutations, n=10) and Class 2 (missense mutation or other variants of unknown significance without protein loss, n=8) for intergroup comparison. Seventeen cases were diagnosed with non-small cell lung cancer (NSCLC) and one was diagnosed with thoracic SMARCA4-deficient undifferentiated tumor (SD-UT). Genotype-phenotype correlation analysis revealed that truncating mutations consistently led to protein loss, whereas missense mutations mostly did not. Two cases with protein loss but negative genetic testing results were identified. Class 1 alterations showed trends towards higher tumor mutational burden (TMB) (median 9.3 vs 4.7 Muts/Mb) and lower programmed cell death ligand 1 (PD-L1) expression (60.0% vs 25.0% with <1% expression) compared to Class 2, but the differences were not statistically significant (P>0.05). Two patients with co-occurring epidermal growth factor receptor (EGFR) L858R mutations showed poor initial response to third-generation EGFR-tyrosine kinase inhibitor monotherapy, but the efficacy was observed after combination with other therapies. Among stage IV patients, the median overall survival (OS) was 10.3 months for Class 1 and 19.9 months for Class 2 (P=0.967). Fourteen patients (77.8%) received immune checkpoint inhibitors (ICIs) combined with chemotherapy. Among them, 8 patients (57.1%) achieved an OS exceeding 12 months, and 7 patients (50.0%) exceeded 24 months. SMARCA4 gene mutations are not entirely consistent with IHC protein loss, necessitating combined interpretation. When SMARCA4 alterations co-exist with EGFR mutations, targeted monotherapy efficacy may be limited, and combination strategies should be considered. Classifying SMARCA4 alterations into Class 1 and Class 2 may have prognostic implications and could help predict the tumor immune microenvironment status (TMB and PD-L1). ICIs combined with chemotherapy is currently one of the main treatment options for patients with advanced SMARCA4-altered pulmonary tumors and showed potential efficacy in this study. 【中文题目：18例SMARCA4缺失或基因突变肺部肿瘤患者的临床病理与基因特征以及预后分析】 【中文摘要：背景与目的 SMARCA4变异肺部肿瘤的诊断主要依赖于免疫组化（immunohistochemistry, IHC）检测蛋白缺失，但其与基因检测结果的一致性以及不同突变类型所导致的临床与生物学差异仍有待进一步探索。本研究旨在探讨该类肿瘤的临床病理、基因特征及预后。方法 回顾性纳入18例经IHC或基因检测证实为SMARCA4缺失/基因突变的肺部肿瘤连续病例，进行临床基因特征和预后分析。根据变异类型分为1类（蛋白缺失或功能丧失性基因突变，n=10）和2类（错义突变或其他意义不明突变且蛋白非缺失，n=8），并进行组间比较。结果 17例为非小细胞肺癌（non-small cell lung cancer, NSCLC），1例为胸部SMARCA4缺失型未分化肿瘤（SMARCA4-deficient undifferentiated tumor, SD-UT）。基因型与表型分析显示：截短突变均导致蛋白缺失，错义突变多不引起缺失，2例蛋白缺失但基因检测阴性。1类较2类变异有更高的肿瘤突变负荷（tumor mutational burden, TMB）（中位数：9.3 vs 4.7 Muts/Mb）和更低的程序性死亡-配体1（programmed cell death ligand 1, PD-L1）表达（<1%者占比：60.0% vs 25.0%）趋势，但差异无统计学意义（P>0.05）。2例表皮生长因子受体（epidermal growth factor receptor, EGFR）L858R共突变患者初始第三代EGFR靶向单药疗效不佳，联合其他治疗见效。IV期患者中1类与2类变异的中位总生存期（overall survival, OS）分别为10.3和19.9个月（P=0.967）。14例（77.8%）患者接受了免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）联合化疗，其中8例（57.1%）OS超12个月，7例（50.0%）超24个月。结论 SMARCA4基因突变与蛋白缺失不完全一致，需联合判读。SMARCA4变异与EGFR突变共存时，单药靶向疗效可能有限，应考虑联合策略。将SMARCA4变异区分为1类与2类，可能具有预后提示价值，并有助于预测肿瘤的免疫微环境状态（TMB及PD-L1）。ICIs联合化疗的方案可能是目前SMARCA4变异晚期肺部肿瘤患者的主要治疗选择之一，在本研究中显示出潜在疗效。
】 【中文关键词：肺肿瘤；胸部SMARCA4缺失型未分化肿瘤；SMARCA4突变；SMARCA4 (BRG1)缺失；EGFR突变；靶向治疗；免疫检查点抑制剂；预后】.
To investigate the molecular mechanism by which fecal microbiota transplantation (FMT) alleviates gastrointestinal inflammation after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in murine acute graft-versus-host disease (aGVHD). A murine aGVHD model after allo-HSCT was established, and BALB/c mice were randomly assigned to blank control, bone marrow transplantation, aGVHD model, and FMT treatment groups (n=6 per group). Disease severity was assessed by histopathology. Expression of receptor-interacting protein kinase (RIPK)1, RIPK3, and mixed lineage kinase domain-like protein (MLKL) was evaluated by immunohistochemistry. Protein levels of RIPK1, RIPK3, MLKL, phosphorylated RIPK1 (p-RIPK1), and phosphorylated MLKL (p-MLKL) were determined by Western blotting. Plasma regenerating islet-derived protein 3 alpha (Reg3α) was measured by enzyme-linked immunosorbent assay. The intestinal microbiota was profiled by 16S rRNA gene sequencing. Compared with the aGVHD model group, the FMT group showed higher relative abundances of Firmicutes and Bacteroidetes and a lower relative abundance of Proteobacteria; body weight loss was markedly attenuated, and survival time was prolonged. Alpha-diversity indices (Simpson, Pielou, Shannon) increased in the FMT group (P<0.05). Intestinal pathology scores, expression of RIPK1, RIPK3, and MLKL, protein levels of RIPK1, RIPK3, MLKL, p-RIPK1, and p-MLKL, and plasma Reg3α levels were significantly reduced in the FMT group versus the aGVHD model group (all P<0.05). FMT may attenuate gastrointestinal inflammation in aGVHD by restoring intestinal microbial balance and inhibiting the RIPK1/RIPK3-mediated necroptosis pathway. 目的: 探讨粪菌移植（fecal microbiota transplantation, FMT）改善小鼠异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation, allo⁃HSCT）后急性移植物抗宿主病（acute graft⁃versus⁃host disease, aGVHD）胃肠道炎症反应的分子机制。方法: 建立小鼠aGVHD模型，将BALB/c小鼠随机分为空白对照组、骨髓移植组、aGVHD模型组、FMT治疗组，每组6只。通过组织病理学检查观察各组小鼠组织病理学损伤情况，采用免疫组织化学检测受体相互作用蛋白激酶（receptor⁃interacting protein kinase, RIPK）1、RIPK3、混合谱系激酶结构域样蛋白（mixed lineage kinase domain⁃like protein, MLKL）表达，Western blot法检测RIPK1、RIPK3、MLKL、磷酸化RIPK1（phosphorylated RIPK1, p⁃RIPK1）、磷酸化MLKL（phosphorylated MLKL, p⁃MLKL）蛋白表达水平，酶联免疫吸附试验检测血浆中再生胰岛衍生蛋白3α（regenerating islet⁃derived protein 3 alpha, Reg3α）含量。通过16S rRNA基因测序对肠道菌群进行分析。结果: 与aGVHD模型组相比，FMT治疗组厚壁菌门、拟杆菌门相对丰度升高，变形菌门相对丰度降低;小鼠体重下降趋势明显缓解，死亡发生时间延缓。与aGVHD模型组相比，FMT治疗组α多样性指数（Simpson, Pielou, Shannon）升高（P<0.05），肠道病理评分和RIPK1、RIPK3、MLKL表达及RIPK1、RIPK3、MLKL、p⁃RIPK1、p⁃MLKL蛋白表达水平、血浆Reg3α水平显著降低（P<0.05）。结论: FMT可能通过重建肠道菌群平衡，抑制RIPK1/RIPK3介导的坏死性凋亡通路，减轻aGVHD胃肠道炎症反应。.
To investigate the efficacy and safety of reduced-dose emicizumab (EMI) prophylaxis in infants under one year of age with severe hemophilia A (HA). Medical records of 11 infants aged ≤12 months with severe HA who received reduced-dose EMI in the Department of Hematology and Oncology, Shenzhen Children's Hospital, from July 2022 to June 2025 were retrospectively reviewed. Efficacy and safety were analyzed statistically. The median age at EMI initiation was 7.9 months (range 4.2-11.2 months). The median loading dose (first 4 weeks) and median maintenance dose were 6.2 mg/kg per 4 weeks (range 2.8-12.6 mg/kg per 4 weeks) and 3.1 mg/kg per 4 weeks (range 2.0-4.8 mg/kg per 4 weeks), respectively. The median duration of EMI prophylaxis was 15.8 months (range 1.7-36.0 months). After treatment, the median (range) annualized bleeding rate, spontaneous annualized bleeding rate, and annualized treated bleeding rate were 0.5 (0-6.2), 0 (0-0.5), and 0 (0-3.0), respectively. All decreased compared with pre-treatment, and the reduction in spontaneous annualized bleeding rate was statistically significant (P<0.05). Overall, 64% (7/11) of patients experienced no bleeding events requiring treatment. No EMI-related adverse events were observed. Reduced-dose EMI prophylaxis effectively controls bleeding in infants with hemophilia A and shows good safety. 目的: 探讨1岁以下重型血友病A（hemophilia A, HA）患儿接受减低剂量艾美赛珠单抗（emicizumab, EMI）治疗的有效性和安全性。方法: 回顾性收集2022年7月—2025年6月于深圳市儿童医院血液肿瘤科接受减低剂量EMI治疗的11例年龄≤12个月的重型HA患儿资料，对其治疗的有效性及安全性进行统计分析。结果: 11例患儿开始使用EMI的中位年龄（范围）为7.9（4.2~11.2）个月，EMI的中位负荷剂量（最初4周的剂量）（范围）和中位维持剂量（范围）分别为6.2（2.8~12.6）mg/（kg·4周）和3.1（2.0~4.8）mg/（kg·4周）。EMI预防治疗的中位时长（范围）为15.8（1.7~36.0）个月。治疗后出血指标:年化出血率、自发性年化出血率及年化治疗出血率的中位数（范围）分别为0.5（0~6.2）、0（0~0.5）和0（0~3.0），均较治疗前降低，其中自发性年化出血率在治疗前后的差异具有统计学意义（P<0.05）。64%（7/11）的患儿未发生需治疗的出血事件，所有患儿均无EMI相关不良事件。结论: 减低剂量EMI用于婴儿血友病A患者预防治疗可以有效控制出血，治疗效果显著，安全性好。.
Based on Professor ZHANG Jin's research on acupuncture manipulation techniques, this paper systematically reviews the historical origin and theoretical connotation of the techniques "Green Dragon Wags Tail" and "White Tiger Shakes Head". In combination with classical medical texts such as Jinzhen Fu, Zhenjiu Wendui, Yixue Rumen, and Zhenjiu Dacheng, the key points of the complete operational system of the "flying through meridians and conducting qi" techniques, including the two methods of "Green Dragon Wags Tail" and "White Tiger Shakes Head", are clarified. Specifically, during treatment, after the needle is inserted into the acupoint and arrival of qi is obtained, the needle is directed toward the diseased area, and "Green Dragon Wags Tail" (shallow needling) or "White Tiger Shakes Head" (deep needling) is performed, and supplemented with the pressing along the meridian. 基于张缙教授对针刺手法的研究，系统梳理青龙摆尾、白虎摇头手法的历史源流与理论内涵，结合《金针赋》《针灸问对》《医学入门》《针灸大成》等古典医籍记载，明确包括青龙摆尾、白虎摇头二法在内飞经走气手法完整操作体系的要点，即操作时，针刺入腧穴得气，针向病所，押手闭气，施青龙摆尾（刺浅）或白虎摇头（刺深），辅以循摄手法。.
Estrogen is a lipid-soluble steroid hormone and one of the most important female sex hormones.It mainly functions by interacting with estrogen receptors,maintaining normal physiological and pathophysiological functions of the body,and playing a crucial role in regulating blood glucose homeostasis,metabolism,and physiological processes associated with brain learning and memory.Recent studies have shown that estrogen has potential therapeutic effects on diabetes,cognitive impairment and other diseases.It will provide new ideas and treatment strategies for diabetes,Alzheimer's disease,and their comorbidity by regulating the activity of estrogen and the interaction with estrogen receptors to modulate related pathological and physiological processes.This article reviews the latest research progress in the relationship between estrogen and these diseases,providing a new perspective and prospect for the prevention and treatment of diabetes,Alzheimer's disease,and their comorbidity. 雌激素是一种脂溶性类固醇激素,是最重要的女性性激素之一。它们主要通过与雌激素受体相互作用发挥作用,维持机体的正常生理及病理生理功能,并在调节血糖稳态、新陈代谢、大脑学习和记忆相关的生理过程方面发挥重要作用。近年研究表明,雌激素对糖尿病和认知障碍等疾病存在潜在的治疗作用。通过调控雌激素的活性和与雌激素受体的相互作用调节相关病理和生理过程,将为糖尿病、阿尔茨海默病及二者共病等相关疾病提供新的思路和治疗策略。本文主要综述雌激素与这些疾病之间关系的最新研究进展,为糖尿病、阿尔茨海默病及二者共病的预防和治疗提供新的视角与前景。.
To analyze surveillance data on birth defects among perinatal infants in Guiyang City from 2016 to 2024, predict future trends, and provide a scientific basis for prevention and control strategies. Perinatal birth defect data for Guiyang City during 2016-2024 were collected and statistically analyzed. An ARIMA model was established to predict monthly birth defect incidence for 2025-2026. The average annual incidence rate of birth defects in Guiyang City was 45.1‰, with an overall upward trend (P<0.001). The top five defects overall were congenital heart disease, external ear malformation, polydactyly, clubfoot, and hypospadias, with slight year-to-year variation in ranking; congenital heart disease consistently ranked first. The birth defect detection rate was higher in male infants (48.3‰) than in female infants (41.3‰) (P<0.001), and higher in rural areas (53.2‰) than in urban areas (44.3‰) (P<0.001). Among maternal age groups, the incidence was highest in infants of mothers aged ≥35 years (50.5‰). Most diagnoses were confirmed within 7 days postpartum, accounting for 82.71% of cases (10 489 cases). The ARIMA model predicted monthly mean incidence rates of 84.9‰ in 2025 and 91.2‰ in 2026, indicating a continued upward trend. The incidence of birth defects in Guiyang shows an upward trajectory, with congenital heart disease as the leading defect. Targeted management for key populations such as rural residents and advanced-age pregnant women is recommended; the prenatal screening process should be standardized, and high-risk interventions strengthened via prenatal diagnosis centers to improve the quality of the newborn population. 目的: 分析贵阳市2016—2024年围产儿出生缺陷的监测情况，预测其发展趋势，为贵阳市制定出生缺陷防控策略提供科学依据。方法: 对贵阳市2016—2024年围产儿出生缺陷数据进行收集与统计分析，建立ARIMA模型预测贵阳市2025—2026年的月出生缺陷率。结果: 贵阳市2016—2024年出生缺陷年均发生率为45.1‰，发病率整体呈上升趋势（P<0.001）。总体出生缺陷前5位病种依次为先天性心脏病、外耳畸形、多指/趾、马蹄内翻足和尿道下裂，每年顺位略有变动，其中先天性心脏病持续居首位。男婴出生缺陷检出率（48.3‰）高于女婴（41.3‰）（P<0.001）;乡村（53.2‰）高于城镇（44.3‰）（P<0.001）;≥35岁的产妇在各年龄段中，围产儿出生缺陷发生率最高（50.5‰）。出生缺陷儿确诊以产后7 d为主，占比82.71%（10 489例）。ARIMA模型预测2025年、2026年月均出生缺陷发生率为84.9‰、91.2‰，呈继续上升趋势。结论: 贵阳市出生缺陷发生率呈上升态势，先天性心脏病为主要高发类型。建议聚焦农村、高龄孕妇等重点人群实施专项管理;规范产前筛查流程，依托产前诊断中心强化高风险干预，提升出生人口素质。.
Objective To understand the demand of parents in Xichang city for the sexuality education training of young children,analyze its influencing factors,and then put forward corresponding health education strategies. Methods Through cluster random sampling,8 kindergartens were selected in Xichang city,Sichuan province.The knowledge,attitude and practice scale for sexuality education of young children was used to conduct a questionnaire survey among parents of young children.The chi-square test and the multivariate Logistic regression model were used for data analysis. Results Among the 1 496 parents,the demand rates for kindergarten teacher training and expert training were 53.5% and 46.3%,respectively,and the total demand rate for training was 65.4%.The results of the multivariate Logistic regression analysis showed that higher paternal educational level (OR=1.42,95%CI=1.11-1.82,P=0.006),female parenthood (OR=1.71,95%CI=1.28-2.28,P<0.001),positive attitude (OR=1.64,95%CI=1.24-2.15,P<0.001),willingness to participate in school-based early childhood sex education with children (OR=2.44,95%CI=1.67-3.49,P<0.001),and more diverse sources of knowledge (OR=15.32,95%CI=5.49-42.79,P<0.001) were positive predictors of parents' overall demand for training.Conversely,children's prior participation in sex education-related courses at school (OR=0.57,95%CI=0.38-0.85,P=0.006) was a negative predictor of such demand. Conclusions The parents in Xichang city have high demand for the sexuality education training of young children but limited ways to knowledge sources.It is recommended that sexuality education training courses both online and offline should be developed according to the characteristics of parents' needs,and the contents,methods,and ways of health education should be optimized.Special attention should be paid to the health education for male parents,parents with low educational attainment,parents with a passive attitude,and parents who have cognitive misunderstandings about or lack knowledge of children's sexuality education.Efforts should be made to popularize sexuality education knowledge,enhance parents' ability to conduct sexuality education for young children,and improve the quality of family sexuality education through home-school cooperation,thus creating a healthy growth environment for young children. 目的 了解西昌市家长对幼儿性教育培训的需求情况,并分析其影响因素,进而提出相应的健康教育策略。方法 采用整群随机抽样方法在四川省西昌市抽取8所幼儿园,对幼儿家长使用《幼儿性教育知信行量表》进行问卷调查,采用χ2检验和多因素Logistic回归模型进行数据分析。结果 1 496名家长的幼儿园教师培训需求率为53.5%,专家培训需求率为46.3%,培训总需求率为65.4%。多因素Logistic回归分析显示,父亲文化程度高(OR=1.42,95%CI=1.11~1.82,P=0.006)、女性家长(OR=1.71,95%CI=1.28~2.28,P<0.001)、态度积极(OR=1.64,95%CI=1.24~2.15,P<0.001)、愿意和孩子一起参加学校的幼儿性教育(OR=2.44,95%CI=1.67~3.49,P<0.001)、知识来源途径数量多(OR=15.32,95%CI=5.49~42.79,P<0.001)是家长培训总需求的促进因素,孩子在学校参加过性教育相关课程情况(OR=0.57,95%CI=0.38~0.85,P=0.006)是家长培训总需求的抑制因素。结论 西昌市家长幼儿性教育培训需求较高,获取知识来源途径较少。建议针对家长需求特点结合线上线下开展性教育培训课程,优化并完善健康教育内容、方式和途径。重点加强男性家长、文化程度相对较低、态度不积极以及对幼儿性教育存在认知误区或缺乏了解的家长的健康教育,普及性教育知识,提升家长的幼儿性教育能力,通过家校合作的方式提高家庭性教育质量,为幼儿营造健康的成长环境。.
To observe the long-term clinical efficacy and safety of fire needling in the treatment of knee osteoarthritis. Sixty patients with knee osteoarthritis were randomized into an observation group (30 cases, 4 cases dropped out, 1 case was eliminated) and a control group (30 cases, 4 cases dropped out, 2 cases were eliminated). Yanglingquan (GB34), Neixiyan (EX-LE4), Dubi (ST35), Xuehai (SP10), Liangqiu (ST34) and 1-2 ashi points on the affected side were selected in the two groups. Fire needling was applied in the observation group, while conventional filiform needling was applied in the control group. The treatments in both groups were delivered once every other day, 3 times a week for 2 consecutive weeks. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score was observed before and after treatment, as well as at follow-ups of 6 months and 1 year after treatment completion, the clinical efficacy and safety were evaluated after treatment and at follow-ups of 6 months and 1 year after treatment completion. After treatment and at 6-month follow-up, the pain, stiffness, difficulty in daily activities scores and total scores of WOMAC were decreased compared with those before treatment in both groups (P<0.05). At 1-year follow-up, the pain, stiffness, difficulty in daily activities scores and total score of WOMAC were decreased compared with those before treatment in the observation group (P<0.05), the pain score of WOMAC was decreased compared with that before treatment in the control group (P<0.05). After treatment, the pain score, stiffness score and total score of WOMAC in the observation group were lower than those in the control group (P<0.05). At 6-month follow-up, the pain, stiffness, difficulty in daily activities scores and total score of WOMAC in the observation group were lower than those in the control group (P<0.05). At 1-year follow-up, the stiffness score, difficulty in daily activities score and total score of WOMAC in the observation group were lower than those in the control group (P<0.05). At 6-month follow-up, the total effective rate was 76.0% (19/25) in the observation group, which was higher than 41.7% (10/24) in the control group (P<0.05). At 1-year follow-up, the total effective rate was 64.0% (16/25) in the observation group, which was higher than 33.3% (8/24) in the control group (P<0.05). No acupuncture-related adverse reactions or events occurred in the two groups. Fire needling effectively improves the symptoms of KOA, and has a definite long-term clinical efficacy. 目的：观察火针疗法治疗膝骨关节炎的远期临床疗效及安全性。 方法：将60例膝骨关节炎患者随机分为观察组（30例，脱落4例、剔除1例）和对照组（30例，脱落4例、剔除2例）。两组均取患侧阳陵泉、内膝眼、犊鼻、血海、梁丘、阿是穴1~2个，观察组予火针治疗，对照组予毫针针刺治疗，均隔日1次，每周3次，连续治疗2周。分别在治疗前后及治疗结束后6个月、1年随访时观察两组患者西安大略和麦克马斯特大学骨关节炎指数（WOMAC）量表评分，并在治疗后及治疗结束后6个月、1年随访时评定两组临床疗效及安全性。 结果：治疗后及随访6个月，两组患者WOMAC量表疼痛、僵硬、日常活动难度评分及总分均较治疗前降低（P<0.05）；随访1年，观察组患者WOMAC量表疼痛、僵硬、日常活动难度评分及总分均较治疗前降低（P<0.05），对照组患者WOMAC量表疼痛评分较治疗前降低（P<0.05）。治疗后，观察组患者WOMAC量表疼痛、僵硬评分及总分均低于对照组（P<0.05）；随访6个月，观察组患者WOMAC量表疼痛、僵硬、日常活动难度评分及总分均低于对照组（P<0.05）；随访1年，观察组患者WOMAC量表僵硬、日常活动难度评分及总分均低于对照组（P<0.05）。随访6个月，观察组总有效率为76.0%（19/25），高于对照组的41.7%（10/24，P<0.05）；随访1年，观察组总有效率为64.0%（16/25），高于对照组的33.3%（8/24，P<0.05）。两组患者均未出现与针刺相关的不良反应与不良事件。 结论：火针疗法可有效改善KOA症状，远期临床疗效确切。.
Artificial intelligence (AI) technology is developing rapidly in the medical field, particularly showing significant clinical value in the diagnosis and management of diseases in preterm infants. Preterm infants have immature organ development and a high incidence of complications; early prediction, accurate diagnosis, and individualized treatment pose major clinical challenges. With its powerful data processing and pattern recognition capabilities, AI provides new solutions for the diagnosis and management of diseases in preterm infants. It is now widely applied to the prediction of complications, imaging diagnosis, optimization of treatment plans, and prognostic evaluation for preterm infants, significantly improving diagnostic and therapeutic efficiency and accuracy. However, limitations remain in the clinical application, including data quality, model interpretability, and ethical issues. This article reviews the research progress of AI in the diagnosis and management of diseases in preterm infants, discusses its application advantages, challenges, and future directions, aiming to provide a reference for clinical practice and related research. 人工智能（artificial intelligence, AI）技术在医学领域发展迅速，尤其在早产儿疾病诊疗中展现出重要临床价值。早产儿各器官发育不成熟，并发症发生率高，其早期预测、精准诊断和个体化治疗是临床面临的重大挑战。AI凭借强大的数据处理和模式识别能力，为早产儿疾病诊疗提供了新的解决方案，现已广泛应用于早产儿并发症预测、影像学诊断辅助、治疗方案优化及预后评估等方面，显著提高了诊疗效率和准确性。但当前AI技术在临床应用中仍存在数据质量、模型可解释性及伦理问题等局限性。该文就AI在早产儿疾病诊疗中的研究进展进行综述，探讨其应用优势、挑战及未来发展方向，为临床实践和相关研究提供参考。.
Objective To analyze the accuracy of intraoperative frozen section diagnosis of thyroid lesions in Xizang and explore the methods and measures to improve the diagnosis accuracy. Methods The clinicopathological data of 371 patients with thyroid lesions surgically resected by four hospitals in Xizang from January 2020 to December 2024 were collected.With the paraffin section diagnosis after surgery as the standard,the accuracy,missed diagnosis rate,misdiagnosis rate,and delayed diagnosis rate of frozen section diagnosis were analyzed. Results The intraoperative frozen section diagnosis in 371 cases of thyroid lesions showed the accuracy of 95.42% (354/371),the missed diagnosis rate of 0.27% (1/371),the misdiagnosis rate of 0.54% (2/371),and the delayed diagnosis rate of 3.77% (14/371).One case was subjected to missed diagnosis,which was a papillary carcinoma of the thyroid gland.Two cases were misdiagnosed.One of them was diagnosed as malignant tumor during surgery but nodular goiter with atypical hyperplasia of follicular epithelium after surgery.The other case was diagnosed as medullary carcinoma during surgery but subacute thyroiditis after surgery. Conclusions Frozen section diagnosis is an important method for determining the benign or malignant nature of thyroid lesions during surgery.The diagnosis rates of follicular tumors and small lesions are low during surgery.Standardized sampling,improving the quality of frozen sections,and mastering the microscopic morphological characteristics and diagnostic criteria of frozen sections of thyroid lesions during surgery can improve the accuracy of intraoperative frozen section diagnosis. 目的 分析西藏地区甲状腺病变术中冰冻诊断的准确性,探讨提高准确性的方法和措施。方法 收集2020年1月至2024年12月西藏地区4家医院手术切除的371例甲状腺病变患者的临床病理资料,术后以石蜡诊断为标准,分析冰冻诊断准确率、漏诊率、误诊率和延迟诊断率。结果 371例甲状腺病变的术中冰冻切片病理诊断确诊率为95.42%(354/371),漏诊率为0.27%(1/371),误诊率为0.54%(2/371),延迟诊断率为3.77%(14/371)。漏诊1例,为甲状腺微小乳头状癌,冰冻漏取材。误诊2例,其中1例术中考虑恶性肿瘤,术后为结节性甲状腺肿,伴滤泡上皮非典型增生;1例术中考虑髓样癌,术后诊断亚急性甲状腺炎。结论 冰冻病理诊断是手术中确定甲状腺病变良恶性的重要方法,滤泡性肿瘤、微小病变术中确诊率较低,规范取材、提高冰冻切片质量、熟练掌握甲状腺病变术中冰冻病理的显微镜下形态学特点及诊断标准,可以提高术中冰冻病理诊断准确率。.
Objective To develop an interpretable machine learning model for predicting mortality risk in elderly intensive care unit (ICU) patients with type 2 diabetes mellitus (T2DM) and cerebral infarction,and to identify critical prognostic factors. Methods We extracted data of 514 elderly patients with T2DM and cerebral infarction from the Medical Information Mart for Intensive Care-Ⅳ database.The dataset was partitioned into training and test sets (7∶3 ratio) via scikit-learn.Within the training set,collinearity analysis was conducted,and features with variance inflation factor >5 were excluded.Lasso regression was further adopted to refine the feature selection.Six machine learning models-eXtreme Gradient Boosting (XGBoost),Logistic regression,LightGBM,AdaBoost,decision tree,and gradient boosting decision tree-were constructed and subjected to rigorous five-fold cross-validation.The optimal model was interpreted by SHAP analysis on the test set to determine the hierarchy of mortality-associated predictors and their nonlinear interactions. Results The XGBoost model demonstrated the best training performance and prediction generalization ability.The area under the curve for 30-day and 365-day mortality risk were 0.928 (95%CI=0.853-0.995) and 0.882 (95%CI=0.800-0.963),respectively.SHAP analysis revealed that the Oxford Acute Severity of Illness Score,length of hospital stay,congestive heart failure,length of ICU stay,peripheral capillary oxygen saturation,and heart rate were the top six predictive factors for 30-day mortality risk,while blood urea nitrogen,Oxford Acute Severity of Illness Score,peripheral capillary oxygen saturation,age,heart rate,and respiratory rate were the top six predictive factors for 365-day mortality risk. Conclusion The XGBoost model shows significant potential in predicting mortality risk in elderly ICU patients with T2DM and cerebral infarction,underscoring the importance of key clinical predictors. 目的 针对重症监护病房(ICU)老年2型糖尿病合并脑梗死患者死亡风险预测需求,构建可解释机器学习模型,探索关键预后因素。方法 从重症监护医学信息市场-Ⅳ数据库提取514例患者数据,利用scikit-learn机器学习库将数据集划分为训练集、测试集(7∶3),在训练集内部进行共线性相关分析,并排除方差膨胀因子>5的特征,后使用Lasso回归算法筛选初始特征,以构建极端梯度提升 (XGBoost)、Logistic回归、LightGBM、自适应增强算法、决策树和梯度提升决策树6种机器学习算法,并通过五重交叉验证进行严格验证。使用测试集以SHAP解释最佳模型,确定死亡率相关预测因子的层次及其非线性相互作用。结果 XGBoost模型表现出最好的训练性能和预测泛化能力。30、365 d死亡风险的受试者工作特征曲线下面积分别为0.928(95%CI=0.853~0.995)和0.882(95%CI=0.800~0.963)。SHAP分析显示,牛津急性疾病严重程度评分、住院时间、充血性心力衰竭、入住ICU时间、外周毛细血管血氧饱和度、心率是30 d死亡风险排名前6的预测因子,而血尿素氮、牛津急性疾病严重程度评分、外周毛细血管血氧饱和度、年龄、心率和呼吸频率是365 d死亡风险排名前6的预测因子。结论 XGBoost模型在预测ICU老年2型糖尿病合并脑梗死患者死亡风险方面具有显著潜力,强调了关键临床预测指标的重要性。.
Objective This study aims to systematically analyze the current status of downward referral among rehabilitation physicians in secondary and tertiary hospitals and investigate its influencing factors.By identifying key bottlenecks in the rehabilitation referral process,this study seeks to provide recommendations for optimizing the hierarchical medical system. Methods A multi-stage stratified cluster sampling method was employed to recruit 203 rehabilitation physicians from 33 secondary and tertiary medical institutions across 18 cities in eastern,central,and western China.Data were collected via self-administered online questionnaires,covering demographic characteristics,professional background,and hierarchical medical system-related factors.An ordered multinomial logistic regression model was used to analyze the factors influencing rehabilitation physicians' downward referral behavior. Results After controlling for confounding factors,the nature of the institution in which the doctor worked (OR=0.475, 95%CI=0.245-0.923, P=0.028),downward referral based on the doctor's own clinical experience (OR=0.423, 95%CI=0.217-0.824, P=0.011),the number of outpatient (emergency) visits received in the last week (OR=1.006, 95%CI=1.001-1.011, P=0.018),knowledge of two-way referrals (OR=1.646, 95%CI=1.042-2.601, P=0.033),confidence in correctly judging the timing of patient referrals (OR=1.556, 95%CI=1.013-2.391, P=0.043),and willingness to refer patients downward (OR=1.901, 95%CI=1.366-2.646, P<0.001) were all independent factors influencing rehabilitation physicians' downward referral behavior. Conclusions Rehabilitation physicians' downward referral behavior is influenced by institutional nature,clinical experience,patient volume,referral system awareness,confidence in referral decisions,and referral intention.To enhance referral efficiency and promote the balanced development of rehabilitation services within the hierarchical medical system,this paper proposes the following recommendations:improving bidirectional referral policies,optimizing medical insurance payment structures,strengthening rehabilitation physician training,and encouraging public-private collaboration. 目的 系统分析二、三级医院康复医生向下转诊行为的现状,并探究其影响因素,以揭示当前康复转诊环节的关键瓶颈,为完善分级诊疗体系中的康复转诊流程提供策略建议。方法 采用多阶段分层整群抽样方法,从我国东、中、西部18个城市的33家二、三级医疗机构中抽取203名康复医生作为研究对象。通过网络自填问卷的方式收集数据,问卷内容包括医生的社会人口学特征、职业概况及分级诊疗相关情况。采用有序多分类Logistic回归模型分析康复医生向下转诊行为的影响因素。结果 在控制其他混杂因素后,公立机构的医生(OR=0.475,95%CI=0.245~0.923,P=0.028)、根据本人临床经验办理下转(OR=0.423,95%CI=0.217~0.824,P=0.011)、上周门(急)诊接诊人次越多(OR=1.006,95%CI=1.001~1.011,P=0.018)、对双向转诊的了解程度越高(OR=1.646,95%CI=1.042~2.601,P=0.033)、正确判断患者转诊时机的信心越强(OR=1.556,95%CI=1.013~2.391,P=0.043)、向下转诊患者的意愿越强(OR=1.901,95%CI=1.366~2.646,P<0.001),康复医生向下转诊患者的可能性越高。结论 康复医生的下转行为受医院性质、临床经验、接诊量、转诊认知、判断信心及转诊意愿的影响。建议通过完善双向转诊政策、优化医保支付、加强康复医生培训、鼓励公私协作,提升转诊便利性,促进康复服务的均衡化和分级诊疗体系落地。.
Objective To examine the expression patterns,prognostic relevance,and immune regulatory functions of thymine DNA glycosylase (TDG) across a spectrum of cancer types,with a particular emphasis on its role in lung adenocarcinoma. Methods A comprehensive analysis was conducted using multiple bioinformatics databases to assess TDG expression levels in pan-cancer contexts,as well as its associations with prognosis and immune regulation.The expression and clinical relevance of TDG in lung adenocarcinoma were examined through online platforms such as UALCAN and BEST.Additionally,small interfering RNA targeting TDG was developed,and cell biological function assays were performed to determine the impact of TDG on cell functionality in lung adenocarcinoma.The LinkedOmics database was used to analyze the genes related to TDG and target kinases in lung adenocarcinoma,and their correlations with tumor status.The PRISM database was utilized to examine the correlation between TDG expression and clinical treatment response in lung adenocarcinoma. Results TDG was markedly overexpressed in a variety of cancers,including lung adenocarcinoma,papillary renal cell carcinoma,and gastric cancer (all P<0.001).It held potential as a prognostic biomarker for hepatocellular carcinoma,lung adenocarcinoma,and papillary renal cell carcinoma.The expression of TDG was intricately linked to immune cell infiltration and tumor heterogeneity.In the context of lung adenocarcinoma,the analysis using the TIMER algorithm revealed negative correlations between TDG expression and the infiltration levels of CD4+ T cells,dendritic cells,and B cells (all P<0.001).Furthermore,CIBERSORT analysis demonstrated that TDG expression was positively correlated with activated CD4+ memory T cells (P<0.001),neutrophils (P<0.001),resting NK cells (P<0.001),resting mast cells (P<0.001),M1 macrophages (P<0.001),M0 macrophages (P=0.014),and naive B cells (P<0.001),while it was negatively correlated with regulatory T cells (P<0.001),monocytes (P<0.001),activated mast cells (P<0.001),and memory B cells (P<0.001). Additionally,TDG expression was positively associated with tumor mutational burden (P<0.001),microsatellite instability (P=0.045),mutant-allele tumor heterogeneity (P=0.001),and tumor neoantigens (P<0.001) in lung adenocarcinoma.In lung adenocarcinoma,the expression of TDG was notably elevated in the tumor tissue compared with that in adjacent normal tissue (P<0.001).Male patients exhibited higher levels of TDG expression than female patients (P=0.002),and smokers demonstrated higher TDG expression than non-smokers (P<0.001).Furthermore,TDG expression was correlated with smoking cessation duration (P=0.014).Positive correlations were observed for TDG expression with both clinical T stage (P=0.003) and distant metastasis (P=0.012),while a negative correlation was found with patient prognosis (P=0.030).Furthermore,TDG emerged as an independent prognostic factor for lung adenocarcinoma.In vitro experiments revealed that silencing TDG inhibited the proliferation and migration of lung adenocarcinoma cells (both P<0.05).A correlation analysis between TDG-related genes and target kinases revealed that in lung adenocarcinoma,genes encoding aurora kinase A,cyclin-dependent kinase 2 and other enzymes exhibited positive correlations with TDG expression (all P<0.001).Furthermore,TDG expression demonstrated positive correlations with functional states including the cell cycle,DNA damage,and DNA repair processes (all P<0.001).In addition,the expression of TDG was correlated with the efficacy of treatment in the first course in clinical patients (P=0.007).Specifically,TDG expression levels were higher in the progressive disease group than in the stable disease group (P=0.016),and lower in the complete remission group than in the progressive disease group (P<0.001).Additionally,elevated TDG expression was associated with enhanced resistance to oxaliplatin (P<0.001),carmustine (P<0.001),and olaparib (P=0.004). Conclusion TDG serves as a potential prognostic biomarker,an immunotherapeutic target,and a oncogene in pan-cancer,with particular significance in lung adenocarcinoma. 目的 探究胸腺嘧啶DNA糖基化酶(TDG)在多种癌症中的表达、预后相关性、免疫调节作用及其在肺腺癌中的功能。方法 采用多种生物信息学数据库分析TDG在泛癌中的表达水平及其与预后、免疫调节的相关性。通过UALCAN、BEST等在线分析TDG在肺腺癌中的表达及其临床相关性。设计靶向TDG的小干扰RNA,利用细胞生物学功能实验评估其对肺腺癌细胞功能的影响。利用LinkedOmics数据库分析肺腺癌中TDG的相关基因、靶标激酶及其与肿瘤状态的相关性。利用PRISM数据库分析肺腺癌中TDG表达与临床治疗反应的相关性。结果 TDG在大多数癌症[如肺腺癌、肾乳头状细胞癌、胃癌(P均<0.001)等]中高表达,可作为肝细胞癌、肺腺癌和肾乳头状细胞癌的预后标志物。TDG表达与免疫细胞浸润、肿瘤的异质性密切相关[在肺腺癌中,TIMER 算法显示TDG表达与CD4+ T 细胞、树突状细胞和B 细胞的浸润水平均呈显著负相关(P均<0.001);CIBERSORT分析显示TDG表达与活化CD4+记忆性T细胞(P<0.001)、中性粒细胞(P<0.001)、静息NK细胞(P<0.001)、静息肥大细胞(P<0.001)、M1型巨噬细胞(P<0.001)、M0型巨噬细胞(P=0.014)和初始B细胞(P<0.001)均呈显著正相关,与调节性T细胞、单核细胞、活化肥大细胞和记忆B细胞均呈显著负相关(P均<0.001);TDG表达与肺腺癌中的肿瘤突变负荷(P<0.001)、微卫星不稳定性(P=0.045)、突变等位基因肿瘤异质性(P=0.001)和肿瘤新抗原(P<0.001)均呈显著正相关]。在肺腺癌中,与癌旁正常组织相比,TDG表达显著升高(P<0.001);男性患者TDG的表达水平显著高于女性(P=0.002),吸烟者TDG表达显著高于非吸烟者(P<0.001),并且TDG表达与戒烟年限显著相关(P=0.014)。此外,TDG表达与临床T分期(P=0.003)、远端转移(P=0.012)均呈显著正相关,与患者的预后呈显著负相关(P=0.030);且TDG是肺腺癌的独立预后因子。体外实验显示,沉默TDG抑制肺腺癌细胞的增殖与迁移(P均<0.05)。TDG相关基因和靶标激酶相关性分析显示,在肺腺癌中,极光激酶A、细胞周期蛋白依赖性激酶2等基因与TDG均呈显著正相关(P均<0.001);TDG的表达与细胞周期、DNA损伤、DNA修复等功能状态均呈显著正相关(P均<0.001)。TDG的表达与临床患者首程治疗效果显著相关(P=0.007);与稳定疾病组相比,进展性疾病组中TDG的表达水平更高(P=0.016);与进展性疾病组相比,完全缓解组中TDG的表达水平较低(P<0.001);TDG表达越高,患者对奥沙利铂(P<0.001)、卡莫司汀(P<0.001)、奥拉帕利(P=0.004)越抵抗。结论 在泛癌中,尤其是肺腺癌中,TDG是一种潜在的肿瘤预后生物标志物、潜在免疫治疗靶点和癌基因。.
Trastuzumab deruxtecan is a newly developed antibody-drug conjugate (ADC) designed to overcome human epidermal growth factor receptor 2 (HER2) aberrations. Studies have confirmed that Trastuzumab deruxtecan yields promising efficacy with a manageable safety profile in previously treated non-small cell lung cancer (NSCLC) patients harboring HER2 mutations. However, data on efficacy of Trastuzumab deruxtecan for acquired HER2-amplified NSCLC are limited. Here, we report a case of a patient with metastatic lung adenocarcinoma who developed acquired high-level HER2 amplification (20 copies) after 2nd-line Osimertinib. A partial response (PR) was achieved with reduced-dose Trastuzumab deruxtecan. Plasma next-generation sequencing (NGS) further confirmed successful inhibition of HER2 amplification. 
. 【中文题目：德曲妥珠单抗治疗获得性HER2高水平扩增的EGFR突变肺腺癌：病例报道】 【中文摘要：德曲妥珠单抗是新近研发的抗体偶联药物（antibody-drug conjugate, ADC），用于克服人生长因子受体2（human epidermal growth factor receptor 2, HER2）异常改变。研究已证实其用于既往接受过治疗的HER2突变型非小细胞肺癌（non-small cell lung cancer, NSCLC）患者，疗效可观且安全性可控。然而，该药用于治疗获得性HER2扩增的NSCLC的疗效数据较为有限。本文报道1例转移性肺腺癌患者，在二线奥希替尼治疗后出现获得性HER2的高水平扩增（扩增倍数达20拷贝），经减量德曲妥珠单抗治疗后达到部分缓解（partial response, PR）。血浆二代测序（next-generation sequencing, NGS）结果进一步证实HER2扩增被成功抑制。
】 【中文关键词：肺肿瘤；德曲妥珠单抗；HER2扩增；获得性耐药；病例报道】.
To investigate the clinical features, treatment, and prognosis of pyruvate kinase deficiency (PKD) caused by PKLR gene variants. Clinical data of six patients with PKD who received care at the Affiliated Hospital of Qingdao University from August 2014 to August 2025 were retrospectively analyzed. Of the six patients, five were children with onset in infancy, and one was an adult whose disease onset occurred at school age. All presented with jaundice and anemia, and PKD was confirmed by genetic testing. Two patients underwent splenectomy due to frequent transfusion. Three patients were mild, required no regular transfusion, and did not undergo splenectomy. One patient died. PKD manifests chronic hemolysis with variable clinical severity. Genetic testing is recommended for diagnosis. Curative therapy remains lacking; management is mainly supportive. Splenectomy may reduce transfusion dependence and improve quality of life. 目的: 探讨PKLR基因变异导致丙酮酸激酶缺乏症（pyruvate kinase deficiency, PKD）的临床特点、相关治疗及预后。方法: 回顾性分析2014年8月—2025年8月就诊于青岛大学附属医院6例PKD患者的临床资料。结果: 6例患者中，5例儿童患者均为婴儿期起病，1例成人患者为学龄期起病，均表现为皮肤黄染、贫血，通过基因检测确诊为PKD。2例因频繁输血行脾切除术治疗;3例为轻症，无需定期输血，未行脾切除术;1例死亡。结论: PKD存在慢性溶血表现，临床表现轻重不一，基因检测被推荐用于诊断。目前尚缺乏有效的治愈手段，仍以对症支持治疗为主，脾切除术有助于减轻患者的输血依赖及提高生活质量。.
To compare the clinical efficacy on the common postoperative complications of mixed hemorrhoids between the acupoint thread-embedding therapy combined with conventional treatment and the simple conventional treatment. A total of 68 patients with mixed hemorrhoids and surgery scheduled were randomized into an acupoint thread-embedding group (34 cases, 2 cases were eliminated) and a conventional treatment group (34 cases, 3 cases were eliminated). In the conventional treatment group, the patients received the routine postoperative care. In the acupoint thread-embedding group, besides the postoperative care as the conventional treatment group, the acupoint thread-embedding therapy was operated at Changqiang (GV1), bilateral Chengshan (BL57), Dachangshu (BL25) and Baihuanshu (BL30), once on the 2nd day after surgery. On day 1, 3 and 7 after surgery, the scores of pain visual analogue scale (VAS), perianal edema, wound exudate, state anxiety inventory (S-AI) and Pittsburgh sleep quality index (PSQI) were observed in the two groups, and the clinical efficacy and safety were evaluated. On day 3 and 7 after surgery, the scores of VAS, perianal edema, wound exudate, S-AI, and PSQI were reduced when compared with the scores on day 1 after surgery in the two groups (P<0.05); and these indexes in the acupoint thread-embedding group were lower than those in the conventional treatment group (P<0.05). The total effective rate in the acupoint thread-embedding group was 90.6% (29/32), higher than that (61.3%, 19/31) in the conventional treatment group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). On the base of conventional postoperative care, acupoint thread-embedding therapy can reduce postoperative pain, perianal edema and wound exudate, alleviate anxiety and improve sleep quality in the patients with mixed hemorrhoids, which is more effective than simple conventional treatment. 目的：比较穴位埋线联合常规治疗与单纯常规治疗对混合痔术后常见并发症的临床疗效。 方法：将68例拟行手术治疗的混合痔患者随机分为穴位埋线组（34例，剔除2例）和常规治疗组（34例，剔除3例）。常规治疗组予术后常规治疗，穴位埋线组在常规治疗组基础上联合穴位埋线，穴取长强及双侧承山、大肠俞、白环俞，于术后2 d治疗1次。于术后1、3、7 d观察两组患者疼痛视觉模拟量表（VAS）评分、肛缘水肿评分、创面分泌物评分、状态焦虑量表（S-AI）评分、匹兹堡睡眠质量指数（PSQI）评分，并评定两组临床疗效和安全性。 结果：术后3、7 d，两组患者疼痛VAS评分、肛缘水肿评分、创面分泌物评分、S-AI评分、PSQI评分均较术后1 d降低（P<0.05），且穴位埋线组以上指标均低于常规治疗组（P<0.05）。穴位埋线组总有效率为90.6%（29/32），高于常规治疗组的61.3%（19/31，P<0.05）。两组患者不良反应发生率比较差异无统计学意义（P>0.05）。 结论：在常规治疗的基础上，穴位埋线可减轻混合痔患者术后疼痛、肛缘水肿、创面渗液，改善其焦虑情绪及睡眠质量，疗效优于单纯常规治疗。.
Angiosarcoma is an aggressive malignant endothelial cell tumor of vascular or lymphatic origin,with rapid progression and high mortality.It usually occurs in middle-aged and elderly people,mainly in the skin or subcutaneous or mammary gland.The incidence of angiosarcoma is low,and it is difficult to be timely detected.Due to the lack of effective therapy at present,the mortality rate of this disease is high.This paper reports a case of hepatic and splenic epithelioid angiosarcoma in a young male with sudden splenic rupture as the initial symptom,aiming to deepen clinicians' understanding of this condition and improve the relevant diagnosis and treatment. 血管肉瘤是血管或淋巴来源的侵袭性恶性内皮细胞肿瘤,进展快,死亡率高,通常见于中老年人,主要发生于皮肤、皮下或乳腺。血管肉瘤发病率低,难以早期发现,目前无有效治疗手段,病死率高。现分享1例青年男性以突发脾破裂为首发症状的肝、脾上皮样血管肉瘤的病例,以加深临床医生对肝、脾血管肉瘤的认识,提高相关的诊疗水平。.