Objective To analyze the clinical efficacy and safety of full-course toripalimab combined with induction chemotherapy and concurrent chemoradiotherapy （CCRT） in the treatment of locally advanced nasopharyngeal carcinoma （LANPC）. Methods A total of 96 patients with initially diagnosed LANPC admitted to the Second Affiliated Hospital of Guangxi University of Science and Technology and People's Hospital of Laibin，Guangxi Zhuang Autonomous Region from January 2021 to December 2023 were enrolled. Patients were divided into the immunotherapy group （n=47） and the control group （n=49） based on whether they received immunotherapy. The control group received induction chemotherapy with the GP regimen （gemcitabine+cisplatin） and CCRT，the immunotherapy group received the same regimen as the control group，along with the addition of toripalimab immunotherapy throughout the treatment process. The therapeutic effects of the two groups of patients were compared. Kaplan-Meier survival curves were plotted to evaluate the survival status of the patients，the 2-year failure-free survival （FFS） rate，2-year overall survival （OS） rate，2-year distant metastasis-free survival （DMFS） rate and 2-year locoregional relapse-free survival （LRFS） rate were compared using the log-rank test. The influencing factors of patients' FFS were analyzed using Cox proportional hazards regression model. Adverse events were compared between the two groups. Results By the follow-up deadline，13 patients died，including 6 （12.77%） in the immunotherapy group （1 due to immune-related pneumonitis with infection，5 due to progression or metastasis of nasopharyngeal carcinoma） and 7 （14.28%） in the control group （all due to progression or metastasis of nasopharyngeal carcinoma）. At 3 months after treatment，there were 36 cases of complete response （CR），10 cases of partial response （PR），and 1 case of stable disease （SD） in the immunotherapy group； and 37 cases of CR，10 cases of PR，and 2 cases of SD in the control group. The objective response rate was 97.87% （46/47） in the immunotherapy group and 95.92% （47/49） in the control group，the disease control rates of the two groups were 100% （47/47） and 100% （49/49） respectively，with no statistically significant differences （χ²=0.30，P=0.582； P>0.999）. The 2-year FFS rates of the immunotherapy group and the control group were 85.10% and 67.34% respectively，with a statistically significant difference （χ²=4.23，P=0.040）. The 2-year OS rates were 97.87% and 93.87% respectively，with no statistically significant difference （χ²=1.10，P=0.294）. The 2-year DMFS rates were 89.36% and 79.59% respectively，with no statistically significant difference （χ²=2.00，P=0.158）. The 2-year LRFS rates were 95.74% and 87.75% respectively，with no statistically significant difference （χ²=2.41，P=0.121）. Multivariate analysis showed that，combined immunotherapy，age，gender，pathological type，T stage，N stage，American Joint Committee on Cancer stage，radiation duration, EBV-DNA level，and EBV antibodies were not independent influencing factors of FFS in patients （all P>0.05）. There were no statistically significant differences between the two groups in the incidence of leukopenia，neutropenia，thrombocytopenia，anemia，pneumonia，hypothyroidism，fever，fatigue，weight loss，or gastrointestinal system reactions （all P>0.05）. Conclusions The full-course toripalimab combined with induction chemotherapy and CCRT，although does not significantly improve the short-term efficacy，2-year OS rate，DMFS rate，or LRFS rate of patients with LANPC，it can increase the 2-year FFS rate，and not increase adverse reactions.

Objective To compare the dosimetric differences and characteristics between carbon ion radiotherapy （CIRT） plans and photon radiotherapy plans [intensity-modulated radiation therapy （IMRT） and volumetric modulated arc therapy （VMAT）] in patients with thoracic esophageal cancer. Methods A total of 46 patients with thoracic esophageal cancer who received radiotherapy at Gansu Provincial Hospital and Anyang Tumor Hospital from March 2024 to February 2025 were enrolled，including 19 treated with IMRT and 27 with VMAT. The CT images of all patients were imported into the CIRT planning system CIPlan 2.0，and CIRT plans were generated based on the same patient data. Under the premise of meeting clinical requirements，the dosimetric parameters differences of the target volume and organs at risk were compared among the CIRT，IMRT，and VMAT plans. Results For target dose parameters，the D_2% values of the planning target volume （PTV） in the IMRT，VMAT，CIRT plans were （55.50±1.75），（55.38±1.75），（57.38±0.63） Gy，respectively； the D_98% values were 50.26 （50.04，50.88），49.65 （49.21，50.37），49.96 （49.26，50.62） Gy，respectively； the average dose （Avg） values were 52.79 （52.06，53.64），52.90 （52.32，53.35），53.30 （53.22，53.36） Gy，respectively； the conformity index （CI） values were 0.69 （0.65，0.75），0.75 （0.65，0.83），0.78 （0.74，0.82），respectively； and the homogeneity index （HI） values were 0.10±0.03，0.12±0.04，0.14±0.02，respectively，with statistically significant differences （F=32.93，P<0.001； H=9.39，P=0.009； H=9.90，P=0.007； H=10.94，P=0.004； F=15.03，P<0.001）. Compared with IMRT，VMAT showed a lower D_98% and a higher HI，CIRT showed higher D_2%，CI，and HI （all P<0.05）. Compared with VMAT，CIRT showed higher D_2%，Avg，CI，and HI （all P<0.05）. For organs at risk，the whole-lung V₅ values in the IMRT，VMAT，CIRT plans were （34.26±14.13）%，（37.47±11.35）%，（5.79±2.72）%，respectively； the V₁₀ values were （23.56±10.18）%，（26.26±8.52）%，（4.63±2.14）%，respectively； the V₁₅ values were （17.75±8.32）%，（18.36±6.57）%，（3.95±1.88）%，respectively； the V₂₀ values were （12.55±5.91）%，（12.14±4.86）%，（3.12±1.65）%，respectively； and the V₃₀ values were （4.34±1.89）%，（4.77±2.51）%，（1.80±1.01）%，respectively，with statistically significant differences （F=130.32，P<0.001； F=109.76，P<0.001； F=81.31，P<0.001； F=63.40，P<0.001； F=29.52，P<0.001）. Compared with IMRT and VMAT，CIRT showed lower V₅，V₁₀，V₁₅，V₂₀，V₃₀ values （all P<0.05）. The spinal cord D_max in the IMRT，VMAT，and CIRT plans were 33.13 （28.02，37.39），35.07 （31.90，38.73），7.13 （5.42，17.84） Gy，respectively. The heart V₃₀ values were 10.19 （0.00，20.31）%，10.47 （0.21，20.85）%，1.88 （0.00，4.77）%，respectively，and the heart V₄₀ values were 3.82 （0.00，7.85）%，2.53 （0.00，4.34）%，0.90 （0.00，2.15）%，respectively，with statistically significant differences （H=68.38，P<0.001； H=10.83，P=0.004； H=7.92，P=0.019）. Compared with IMRT and VMAT，CIRT showed lower spinal cord D_max，heart V₃₀，and heart V₄₀ （all P<0.05）. Conclusions For patients with thoracic esophageal cancer undergoing radiotherapy，CIRT has clear dosimetric advantages over IMRT and VMAT in protecting organs at risk. It can significantly reduce the doses to the lungs，heart，and spinal cord while maintaining adequate target dose coverage. IMRT shows better dose homogeneity within the target volume，whereas CIRT demonstrates superior target conformity.

Objective To investigate the relationship between the levels of T-cell immunoglobulin and mucin domain containing protein-3 （TIM-3） and programmed death-1 （PD-1） on the surface of peripheral blood and tumor tissue of CD4⁺ T cells and the efficacy of immunotherapy in cervical cancer，and to analyze the mediating role of macrophage polarization indicators CD68，CD163，arginase-1 （Arg-1），and inducible nitric oxide synthase （iNOS）. Methods A total of 111 patients with cervical cancer treated at 982nd Hospital of Joint Support Force of the People's Liberation Army of China from April 2024 to January 2025 were selected as study subjects. All patients received radical concurrent chemoradiotherapy combined with pembrolizumab immunotherapy，the levels of TIM-3，PD-1，and macrophage polarization indicators were compared between patients with different treatment responses. The levels of TIM-3 and PD-1 were also compared among patients with different clinicopathological characteristics. The influence of macrophage polarization indicators on the levels of TIM-3 and PD-1 was investigated using multiple linear regression analysis. A multivariate generalized linear mixed model （GLMM） was constructed to analyze the effects of TIM-3 and PD-1 on immunotherapy efficacy. Receiver operator characteristic （ROC） curves were used to evaluate the predictive value of TIM-3 and PD-1 for immunotherapy efficacy. Restricted cubic spline analysis was performed to examine the dose-response relationship between TIM-3/PD-1 levels and immunotherapy efficacy. The Bootstrap method was used to analyze the mediating effect of macrophage polarization indicators on the relationship between TIM-3/PD-1 levels and immunotherapy efficacy. Results The overall efficiency rate among 111 patients was 73.87% （82/111）. There were statistically significant differences in the levels of TIM-3，PD-1，CD68，CD163，Arg-1，iNOS of peripheral blood and tumor tissues between effective （n=82） and ineffective patients （n=29） （all P<0.001）. There were statistically significant differences in the levels of TIM-3 and PD-1 of peripheral blood between patients with and without lymph node metastasis （Z=-1.97，P=0.049； Z=2.02，P=0.043）； there were statistically significant differences in the levels of PD-1 of peripheral blood between patients with different differentiation degrees （Z=2.59，P=0.010）； there were statistically significant differences in the levels of TIM-3 of peripheral blood between patients at different International Federation of Gynecology and Obstetrics （FIGO） stages （H=6.65，P=0.036）. There were statistically significant differences in the levels of TIM-3 and PD-1 of tumor tissue between patients with and without lymph node metastasis，as well as among patients with different maximum tumor diameters （Z=-2.52，P=0.012； Z=2.53，P=0.011； Z=-2.83，P=0.005； Z=2.10，P=0.036）； there were statistically significant differences in the levels of TIM-3 of tumor tissue between patients with varying depths of infiltration （Z=-2.43，P=0.015）. After adjusting for other covariates，CD68 （β=1.16，P=0.017； β=1.12，P=0.016），CD163 （β=1.84，P<0.001； β=2.05，P<0.001），Arg-1 （β=1.92，P<0.001； β=1.70，P<0.001），and iNOS （β=-1.59，P<0.001； β=-1.69，P=0.012） were linearly associated with TIM-3 and PD-1 levels of peripheral blood，the trends in CD68，CD163，Arg-1，iNOS and the levels of TIM-3 and PD-1 of tumor tissue were consistent with those in peripheral blood. Medium and high levels of TIM-3 and PD-1 of peripheral blood and tumor tissue were independent risk factors for inefficacy of immunotherapy in cervical cancer （all P<0.05）. The area under the curves （AUCs） for predicting the ineffectiveness of immunotherapy in cervical cancer by the levels of TIM-3 and PD-1 of peripheral blood were 0.80 and 0.84，respectively； the AUCs for the levels of TIM-3 and PD-1 of tumor tissues were 0.86 and 0.91，respectively. The AUCs for the combined peripheral blood indicators （TIM-3+PD-1），the combined tumor tissue indicators （TIM-3+PD-1），and the total combined （all indicators from peripheral blood+tumor tissue） were 0.95，0.96，and 0.98，respectively. The total combined predicted AUC was higher than that of other indicators （Z=6.26，P<0.001； Z=6.04，P=0.001； Z=5.49，P=0.006； Z=5.11，P=0.010； Z=4.21，P=0.019； Z=3.43，P=0.025）. There was a nonlinear dose-response relationship between the levels of TIM-3 and PD-1 in peripheral blood and tumor tissue and immunotherapy inefficacy in cervical cancer. The lowest risk points were 4.78%，15.61%，and 2.87，3.29 points，respectively. The results of the mediation analysis indicated that CD68，CD163，Arg-1，and iNOS played a mediating role in the relationship between the levels of TIM-3 and PD-1 in peripheral blood and tumor tissue and the efficacy of immunotherapy in cervical cancer. Conclusions The levels of TIM-3 and PD-1 in peripheral blood and tumor tissue are higher in patients with ineffective immunotherapy for cervical cancer than those in responders，and their high levels are independent risk factors for immunotherapy inefficacy. The macrophage polarization indicators CD68，CD163，Arg-1，iNOS have a linear correlation with the levels of TIM-3 and PD-1，and they play a mediating regulatory role in the relationship between TIM-3，PD-1 and the efficacy of immunotherapy.

Objective To analyze the application value of multimodal ultrasound imaging [routine two-dimensional ultrasound combined with transvaginal color Doppler sonography （TVCDS），three-dimensional power Doppler ultrasound （3D-PDUS），shear wave elastography （SWE）] in the differential diagnosis of benign and malignant cervical lesions. Methods A total of 94 patients with cervical lesions treated at First Hospital of Qinhuangdao from July 2024 to July 2025 were retrospectively enrolled as research objects. Diagnostic efficiency of different ultrasound and multimodal ultrasound imaging technologies for benign and malignant cervical lesions was evaluated. The differences in TVCDS parameters [peak systolic velocity （PSV），resistance index （RI）]，3D-PDUS parameters [flow index （FI），vascularization index （VI），vascularization-flow index （VFI）] and SWE parameters [mean elasticity value （E_mean），maximum elasticity value （E_max）] among patients with cervicitis，cervical intraepithelial neoplasia and cervical cancer were compared. The diagnostic value of different ultrasound parameters for benign and malignant cervical lesions was evaluated by receiver operator characteristic （ROC） curves. Results Among the 94 patients with cervical lesions，there were 63 cases with benign lesions （38 cases with cervicitis，25 cases with cervical intraepithelial neoplasia） and 31 cases with malignant lesions. Taking the pathological examination results as the golden standard，Kappa values of two-dimensional ultrasound，TVCDS，3D-PDUS，SWE and multimodal ultrasound imaging in the diagnosis of benign and malignant cervical lesions were 0.333，0.534，0.669，0.742，0.976，sensitivity were 67.74% （21/31），74.19% （23/31），80.65% （25/31），87.10% （27/31），100% （31/31），specificity were 68.25% （43/63），80.95% （51/63），87.30% （55/63），88.89% （56/63），98.41% （62/63），accuracy were 68.09% （64/94），78.72% （74/94），85.11% （80/94），88.30% （83/94），98.94% （93/94），positive predictive values were 51.22% （21/41），65.71% （23/35），75.76% （25/33），79.41% （27/34），96.88% （31/32），negative predictive values were 81.13% （43/53），86.44% （51/59），90.16% （55/61），93.33% （56/60），100% （62/62），respectively. The specificity，accuracy and positive predictive value of 3D-PDUS and SWE in the diagnosis of benign and malignant cervical lesions were higher than those of routine two-dimensional ultrasound （all P<0.05）. The sensitivity，specificity，accuracy，positive predictive value and negative predictive value of multimodal ultrasound in the diagnosis of benign and malignant cervical lesions were higher than those of routine two-dimensional ultrasound，TVCDS，3D-PDUS，SWE as single examinations （all P<0.05）. The PSV of the TVCDS parameters in patients with cervicitis，cervical intraepithelial neoplasia and cervical cancer were （10.35±2.21），（13.84±2.61），（17.29±3.07） cm/s，RI were 0.72±0.20，0.63±0.17，0.52±0.12，respectively，with statistically significant differences （F=59.86，P<0.001； F=11.93，P<0.001）. The FI of the 3D-PDUS parameters were 44.48 （37.79，49.45），54.05 （40.13，65.40），57.78 （45.54，71.03），VI were 1.20 （0.87，1.89），3.27 （1.54，4.24），5.23 （2.98，14.77），VFI were 0.57 （0.25，0.96），2.04 （0.74，2.85），9.31 （5.25，19.82），respectively，with statistically significant differences （U=16.60，P<0.001； U=55.97，P<0.001； U=52.18，P<0.001）. The E_mean of the SWE parameters were （20.81±5.61），（30.05±9.06），（80.39±9.27） kPa，E_max were （27.16±7.14），（35.53±8.53），（90.13±8.88） kPa，respectively，with statistically significant differences （F=527.62，P<0.001； F=568.76，P<0.001）. PSV，FI，VI，VFI，E_mean and E_max in patients with cervical intraepithelial neoplasia and cervical cancer were higher than those with cervicitis，while RI was lower than that with cervicitis patients. PSV，VI，VFI，E_mean and E_max in patients with cervical cancer were higher than those with cervical intraepithelial neoplasia，while RI was lower than that with cervical intraepithelial neoplasia （all P<0.05）. ROC curve analysis showed that，area under the curve values of PSV，RI，FI，VI，VFI，E_mean and E_max in the diagnosis of benign and malignant cervical lesions were 0.78，0.75，0.78，0.81，0.79，0.83 and 0.81，respectively. Conclusions Multimodal ultrasound imaging can significantly improve diagnostic accuracy of benign and malignant cervical lesions. PSV，RI，FI，VI，VFI，E_mean and E_max all have certain diagnostic value in benign and malignant cervical lesions.

In recent years，immune checkpoint inhibitors，particularly those targeting the programmed death-1/programmed death-ligand 1 signal pathway，have demonstrated favorable anti-tumor activity in the treatment of advanced triple-negative breast cancer （TNBC）. Both used as a single agent and in combination，they have brought significant clinical benefits to a subset of patients. Combination strategies include co-administration with chemotherapy，targeted therapies （poly ADP-ribose polymerase inhibitors，vascular endothelial growth factor receptor inhibitors，and antibody-drug conjugates），and radiotherapy，with the aim of synergistically enhancing anti-tumor immune responses. Some novel immunotherapies，such as bispecific antibodies，oncolytic viruses and tumor vaccines，have shown initial potential in the treatment of TNBC. Nevertheless，immunotherapy for TNBC faces substantial challenges，including marked heterogeneity in treatment efficacy and complex drug resistance mechanisms，leading to suboptimal overall response rates. Systematically analyzing the current status and advances of clinical research on immunotherapy for advanced TNBC，and exploring its mechanisms of action，characteristics of drug resistance，and corresponding countermeasures，can provide evidence-based references for clinical practice and scientific research.

Postoperative recurrence and metastasis of thoracic esophageal squamous cell carcinoma （ESCC） are key factors affecting patient prognosis. Patterns of postoperative recurrence and metastasis are jointly influenced by multiple factors，including the anatomical location of the tumor，pathological characteristics，biological behavior，pathological response to neoadjuvant therapy，and treatment modalities. With the evolution of neoadjuvant treatment strategies，patterns of postoperative recurrence and metastasis have shifted from a "locoregional recurrence-dominant" pattern of surgery alone，to a "distant metastasis-dominant" pattern of neoadjuvant chemoradiotherapy，and further to a potentially "local-systemic balanced control" pattern with the introduction of immunotherapy. The evolution of postoperative recurrence and metastasis patterns profoundly reflects the mechanisms and limitations of different treatment strategies. A systematic understanding of postoperative recurrence and metastasis patterns in thoracic ESCC，as well as the influencing factors，and conducting an in-depth analysis of the biological mechanisms underlying different treatment strategies，is crucial for optimizing perioperative treatment strategies and improving patient prognosis.

Adenocarcinoma of the esophagogastric junction （AEG） and gastric cancer are common malignant tumors worldwide. Angiogenesis is a key mechanism in tumor development. Currently，anti-angiogenic therapy has become an important strategy for the treatment of AEG and gastric cancer. Anti-angiogenic drugs mainly include monoclonal antibodies （such as bevacizumab and ramucirumab） and small molecule tyrosine kinase inhibitors （such as apatinib，fruquintinib，regorafenib，lenvatinib，anlotinib，sorafenib，and cabozantinib），which can be used as single drugs or in combination for multi-line，neoadjuvant or conversion maintenance treatment of AEG and gastric cancer，and have shown certain survival benefits. An in-depth exploration of the research progress of anti-angiogenic drugs in the treatment of AEG and gastric cancer can provide references for optimizing clinical treatment strategies.

Both myelodysplastic syndromes and Philadelphia chromosome-negative myeloproliferative neoplasms are clonal myeloid disorders originating from hematopoietic stem cells，classified under myelo-proliferative and myelodysplastic diseases. They exhibit considerable heterogeneity and are primarily characterized by ineffective hematopoiesis and an elevated risk of leukemic transformation. Dysregulated iron metabolism contributes to disease progression through multiple mechanisms. In myelodysplastic syndromes，iron overload leads to increased reactive oxygen species，elevation of apoptotic protease-activating factor 1，and elevated growth differentiation factor 11 levels，thereby suppressing the proliferation of hematopoietic stem/progenitor cells and augmenting the risk of leukemic transformation. Furthermore，iron metabolism dysregulation exacerbates disease progression in polycythemia vera patients by aberrantly activating STAT5 signaling during erythropoiesis，and adversely affects the prognosis of those with essential thrombocythemia and myelofibrosis. A thorough investigation into the mechanisms of iron homeostasis imbalance in myelodysplastic/myeloproliferative diseases provides a critical foundation for the subsequent development of targeted and precise therapeutic strategies for iron metabolism.

Tumor-derived exosome （TEX） serves as a core mediator of intercellular information transmission and exerts pivotal regulatory effects on the progression of bone metastasis in malignant tumors by delivering bioactive molecules，including microRNAs，proteins，and lipids. It not only mediate the directed homing of tumor cells to the bone tissue，but also participate in the remodeling of the bone pre-metastatic microenvironment，and further drive the vicious cycle of "tumor growth-bone destruction". Systematically elucidating the specific regulatory mechanisms of TEX in bone metastasis of malignant tumors，and exploring its clinical translational potential as an early diagnostic biomarker for bone metastasis，a therapeutic target，and a drug delivery carrier，can provide new strategies and directions for the precise diagnosis and treatment of malignant tumor bone metastasis.