Objective:To explore the efficacy and safety of immunoneoadjuvant therapy with pembrolizumab combined with chemotherapy in locally advanced resectable hypopharyngeal squamous cell carcinoma patients.Methods:This study was a prospective, single arm, single center clinical study that was opened for enrollment in April 2021. Patients who met the inclusion criteria at the Cancer Hospital of the Chinese Academy of Medical Sciences were treated with neoadjuvant therapy of pembrolizumab combined with cisplatin and paclitaxel, and after treatments, received surgery and postoperative adjuvant therapy. The main endpoint of this study was postoperative pathological complete response (pCR), and other observations included adverse reactions and long-term prognoses of patients after neoadjuvant therapy.Results:By September 2023, a total of 23 patients who underwent neoadjuvant therapy and surgery were enrolled in the study and all patients were males aged 49-74 years. All patients were locally advanced stage, including 3 patients in stage Ⅲ and 20 patients in stage Ⅳ. There were 12 cases of primary lesions with posterior ring involvement accompanied by fixation of one vocal cord and 20 cases of regional lymph node metastases classified as N2. Eighteen cases received a two cycle regimen and 5 cases received a three cycle regimen for neoadjuvant therapy. The postoperative pCR rate was 26.1% (6/23), with no surgical delay caused by adverse drug reactions. The laryngeal preservation rate was 87.0% (20/23). Pharyngeal fistula was the main surgical complication, with an incidence of 21.7% (5/23). The median follow-up time was 15 months, and 3 patients experienced local recurrence.Conclusions:The immunoneoadjuvant therapy of pembrolizumab combined with chemotherapy has a high pCR rate in locally advanced resectable hypopharyngeal squamous cell carcinoma, with increased laryngeal preservation rate and no significant impact on surgical safety.

Objective To explore the changes in serum energy metabolites in patients with peripheral T-cell lymphoma,and investigate serum biomarkers for monitoring peripheral T-cell lymphoma from the perspective of energy metabolism.Methods Multiple/selected reaction monitoring(MRM/SRM)was used to detect the energy-related metabolites in the sera of 16 patients with newly diagnosed peripheral T-cell lymphoma admitted in the Hematology Medical Center of the Second Affiliated Hospital of Army Medical University from November 2020 to December 2021,as well as 10 recruited healthy volunteers.The corresponding clinical data including medical history,laboratory results and image data were collected and retrospectively analyzed.Results Significant differences were seen in the contents and expression profiles of serum energy metabolism-related products between the patients and the healthy volunteers.The patients had significantly reduced serum contents of cyclic AMP,succinate,citrate and cis-aconitate(P＜0.05),and elevated D-glucose 6-phosphate content(P＜0.05).The serum contents of citrate and succinate were negatively correlated with the risk stratification(low-,moderate-and high-risk)and clinical stage of the disease(P＜0.05).Meanwhile,there was a negative correlation between the contents of L-malic acid and citrate and the mid-term efficacy evaluation results,such as complete/partial response(CR/PR)or stable disease(SD)(P＜0.05).For patients with extranodal NK/T cell lymphoma(n=10),there were also significant reductions in the contents of cyclic AMP,succinate,citrate,isocitrate and cis-aconitate in the sera of patients compared with healthy volunteers(P＜0.05),and the contents of citrate and succinate were negatively correlated with the clinical stage(P＜0.05)and were rather correlated with mid-term efficacy evaluation results(CR/PR or SD)(P＜0.05).For patients with angioimmunoblastic T-cell lymphoma(n=6),the serum contents of cyclic AMP,citrate and succinate were significantly lower,while the content of D-glucose 6-phosphate was higher when compared with the healthy volunteers(P＜0.05),and the content of succinate was negatively correlated with both clinical stage and risk grade of the patients(P＜0.05).Conclusion There are 5 serum differential metabolites identified between patients with peripheral T-cell lymphoma and healthy controls,and succinate and citrate are expected to be serum biomarkers of peripheral T-cell lymphoma.

Global Burden of Disease ; Risk Factors ; Quality-Adjusted Life Years

Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.

Objective:To compare the clinical efficacy of endoscopic resection and laparoscopic surgery in the treatment of gastric gastrointestinal stromal tumor (GIST) with a maximum diameter of 2 to 5 cm, and to analyze the influence of factors such as tumor surface, growth pattern and lesion origin on the choice of resection method, so as to provide a safer and more effective treatment for patients with gastric GIST.Methods:From January 2012 to November 2019, at the First Affiliated Hospital of Zhengzhou University, the clinical data of 301 patients with gastric GIST who underwent endoscopic resection (137 cases in the endoscopic resection group) or laparoscopic surgery (164 cases in the laparoscopic surgery group) were retrospectively analyzed, including age, gender, whether there was depression on the tumor surface (the local subsidence depth of the mucosa on the tumor surface was >5 mm), whether the tumor surface was irregular (non-hemispherical or non-elliptical tumor surface), whether there was combined ulcer, location, shape, origin of the lesion, growth pattern (intralumina growth or combined intraluminal and extraluminal growth), risk classification (very low risk, low risk, medium risk, high risk), whether the tumor was en bloc resection, operation time, whether bleeding or not, fasting time, indwelling time of gastric tube, time of hospitalization, time of postoperative hospital stay, postoperative complications and follow-up. Independent sample t test, chi-square test or Fisher′s exact test and Wilcoxon rank sum test were used for statistical analysis. Results:Among the 137 patients with gastric GIST in the endoscopic resection group, 85 cases (62.0%) underwent endoscopic submucosal dissection, 9 cases (6.6%) underwent endoscopic submucosal excavation, 42 cases (30.7%) underwent endoscopic full-thickness resection, and 1 case (0.7%) underwent submucosal tunnel endoscopic resection. There were no significant differences in gender, age, lesion location, tumor size, and risk classification between the endoscopic resection group and the laparoscopic surgery group (all P>0.05). The tumor surface was depressed, with ulcer or irregular in 1, 49, 26, and 2 cases of patients with gastric GIST of very low risk, low risk, medium risk and high risk, respectively. There was statistically significant difference in the proportion of depression, irregularity and ulcer on the tumor surface at different risk levels ( Z=-2.55, P=0.011). The complete tumor resection rate of the endoscopic resection group was lower than that of the laparoscopic surgery group (86.1%, 118/137 vs. 100.0%, 164/164), and the difference was statistically significant ( χ2=24.28, P<0.001). However the operation time, fasting time, the indwelling time of gastric tube, time of hospitalization, and the time of postoperative hospital stay of the endoscopic resection group were shorter than those of the laparoscopic surgery group, and the total hospitalization cost was lower than that of the laparoscopic surgery group (90.0 min (62.5 min, 150.0 min) vs. 119.5 min, (80.0 min, 154.2 min); 3 d (3 d, 4 d) vs. 5 d (4 d, 7 d); 3 d (2 d, 4 d) vs. 4 d (2 d, 6 d); 11 d (10 d, 14 d) vs. 16 d (12 d, 20 d); 7 d (6 d, 9 d) vs. 9 d (7 d, 11 d); (38 211.6±10 221.0) yuan vs. (59 926.1±17 786.1) yuan), and the differences were statistically significant ( Z=-2.46, -7.12, -4.44, -6.89 and -5.92, t=-13.24; all P<0.05). The incidence of postoperative abdominal pain and other severe postoperative complications (including shock, respiratory failure, pulmonary embolism, gastroparesis, etc.) of the endoscopic resection group were all lower than those of the laparoscopic surgery group (16.8%, 23/137 vs. 27.4%, 45/164; 0.7%, 1/137 vs. 4.9%, 8/164), and the differences were statistically significant ( χ2=4.84, Fisher′s exact test, P=0.028 and 0.043). There were no significant differences in the incidence of intraoperative bleeding, postoperative bleeding, fever and perforation between the two groups (all P>0.05). The incidence of operation-related complications of lesions with intraluminal growth and originating from muscularis propria in the endoscopic resection group were lower than those of the laparoscopic surgery group (19.5%, 25/128 vs. 32.6%, 45/138; 12.6%, 12/95 vs. 31.4%, 37/118), and the differences were statistically significant ( χ2=5.86 and 10.42, P=0.016 and 0.001). There was no significant difference in the postoperative tumor recurrent rate between the endoscopic resection group and the laparoscopic surgery group (0, 0/137 vs. 2.4%, 4/164; Fisher’s exact test, P=0.129). Conclusions:Endoscopic treatment is safe and effective for gastric GIST with a maximum diameter of 2 to 5 cm, which is superior to laparoscopic surgery. However, laparoscopic surgery is recommended for tumor with depressed, ulcerative, or irregular surface and combined intraluminal and extraluminal growth.

Data of 55 cases of gastric neuroendocrine neoplasms (G-NENS) with diameter ≤12 mm in the First Affiliated Hospital of Zhengzhou University from August 2014 to August 2019 were retrospectively analyzed. According to the methods of endoscopic resection, the patients were divided into two groups: the endoscopic mucosal resection with a cap (EMR-C) group (35 cases) and the endoscopic submucosal dissection (ESD) group (20 cases). The results showed that the success rates of operation, the whole resection rates and the complete resection rates were all 100.0% in the two groups. Compared with the ESD group, the EMR-C group had a shorter median operation time (12.00 min VS 28.35 min, P<0.001), less mean hospitalization costs (21 165.19 yuan VS 28 400.35 yuan, P=0.004), and a similar overall incidence of complications [2.86% (1/35) VS 0, P=1.000]. By March 2020, the recurrence rate of EMR-C group and ESD group were 28.6% (10/35) and 15.0% (3/20), respectively, without significant difference ( P=0.418). It is suggested that for G-NENS with diameter ≤12 mm, without muscular invasion, lymph node metastasis or distant metastasis, EMR-C and ESD are both safe and effective, but EMR-C has more advantages in terms of operation time and hospitalization costs.

Objective:To explore the application value of cloud follow-up platform in transitional nursing of elderly patients with gastric cancer.Methods:By the convenient sampling method, a total of 108 elderly patients who underwent radical gastrectomy in the First Affiliated Hospital of Zhengzhou University from April 2016 to April 2018 after radical gastrectomy were selected as the research objects. According to the random envelope method, they were divided into the observation group and the control group, with 54 cases in each group. Patients in the control group were given routine follow-up nursing while patients in the observation group were given transitional nursing bases on the cloud follow-up platform and the intervention lasted for 12 months. The Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) , Herth Hope Index, General Self-Efficacy Scale and 14-Item Resilience Scale (RS-14) were used to evaluate intervention effects.Results:After intervention, the overall health status score of EORTC QLQ-C30 was (87.35±15.84) , Herth Hope Index was (44.93±4.19) , General Self-Efficacy Scale score was (31.37±2.80) and RS-14 score was (69.06±8.43) in the observation group, which were all higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Cloud follow-up platform is helpful to improve the quality of life, hope level, sense of self-efficacy and resilience level of elderly patients with gastric cancer after radical gastrectomy.

Objective:To explore the effect of binary reminiscence therapy on the hope level of elderly patients undergoing colorectal neoplasms surgery and the positive feelings of care of their spouses.Methods:Using the convenient sampling method, 96 patients who underwent surgical treatment for colorectal neoplasms in the First Affiliated Hospital of Zhengzhou University from February to November 2019 and their spouses were selected as the research objects. The 47 patients hospitalized from February to June 2019 and their spouses were set as the control group, and the 49 patients hospitalized from July to November 2019 and their spouses were set as the observation group. The control group received routine perioperative nursing of colorectal neoplasms, while the observation group received binary reminiscence therapy on the basis of routine nursing. The Herth Hope Scale (HHI) and the Positive Aspects of Caregiving Instrument (PAC) were used to evaluate the effects of intervention.Results:There was no statistically significant difference in scores of all dimensions of HHI between the two groups at the time of admission ( P>0.05) . The scores of all dimensions of HHI in the observation group were higher than those in the control group before discharge, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in PAC scores of the spouses in the two groups at the time of admission ( P>0.05) . The scores of each dimension of PAC in the observation group were higher than those in the control group before discharge, and the differences were statistically significant ( P<0.05) . Conclusions:Binary reminiscence therapy can improve the hope level of patients with colorectal neoplasms and positive feelings of care of their spouses.

Objective To compare clinical data of the death in different intensive care unit,in order to provide the medical strategies for patients in EICU.Methods The clinical data of lethal cases from January 1,2013 to December 31,2014 in EICU,SICU and MICU of the First Affiliated Hospital of Sun Yat-sen University were compared.EICU (252 cases),SICU (93 cases) and MICU (80 cases) were enrolled.The demographics of each patient,clinical condition such as critical score (APACHE Ⅱ score),length of stay,overall costs,and the patient families' different opinions to the treatment in each ICU were analyzed.The data was analyzed with SPSS 13.0 software,averaged value was presented as mean ± standard and the non-normal distributions were expressed as median (25％,75％).The one-way analysis of variance was followed by the Tukey post hoc test for pairwise comparisons and chi-square test was used for comparison of percentage between two groups.Results Two hundred and fifty-two cases in EICU had gender ration of 148/96 (male/female),92 cases in SICU 68/24,80 cases in MICU 56/24.Ages of the fatal were EICU 72 ± 17 years,SICU 56 ± 17 years,and MICU 63 ± 20 years,respectively.Age of the fatal in EICU was significantly older than that of the SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).APACHE Ⅱscores were 33 ± 8 in EICU,34 ± 10 in SICU,29 ± 10 in MICU,respectively.The severity scores in EICU patients were higher than those in MICU patients and SICU patients (P =0.01 and 0.021).Lengths of stay were 2 days (1,46) in EICU,14 days (1,84) in SICU,12 days (1,77) in MICU,respectively.EICU hospitalization time was significantly shorter than that of SICU (P ＜ 0.01) and the MICU (P ＜ 0.01).Total costs of hospitalization were 9 777 yuan (400,164 126) yuan in EICU,100 628 yuan (13 639,964 783) yuan in SICU,119 463 yuan (5 650,590 903) yuan in MICU,and that in EICU was significantly less than the total cost of hospitalization in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).The opinion of patient families was proposed to give up treatment associated with 165 dead cases in EICU,18 death cases in SICU and 20 dead cases in MICU,and the rate of discontinuous treatment in EICU patients was significantly greater than that in SICU (P ＜ 0.01) and in MICU (P ＜ 0.01).There were no significant differences in invasive procedures,invasive hemodynamic monitoring,mechanical ventilation,blood purification and deep vein puncture among three groups.The 5 leading causes in EICU were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced malignancy.Conclusions The death of patients were due to advanced age with severe disease,poor prognosis,and the request of patient family members to give up treatment.The 5 leading causes were severe sepsis,stroke,sudden cardiac arrest,acute myocardial infarction and advanced tumors suggesting the establishment of corresponding treatment scheme to be made and preparation of abundant medical resources to be ready.Timely communication with the patients' families and let them participate in end-stage treatment decisions was the best strategies to improve the successful rate of treating severe patients and use EICU resource effectively.

OBJECTIVE:To observe clinical efficacy of Felodipine sustained-release tablets(Ⅱ)in the treatment of elderly es-sential hypertension and its improvement effect on arterial elasticity,left ventricular remodeling and the quality of life. METHODS:A total of 96 elderly patients with essential hypertension in our hospital during Aug. 2014-Dec. 2015 were divided into observation group (50 cases) and control group (46 cases) according to random number table. Observation group was given Felodipine sus-tained-release tablets(Ⅱ)5 mg orally,qd,with empty stomach in the morning;control group was given Irbesartan tablets 150 mg, qd,with empty stomach in the morning. Both groups received treatment for 12 weeks. Clinical efficacies of 2 groups were observed as well as 24 h ambulatory blood pressure (ABP),indexes of arlerial elasticity [carotid-radial pulse wave velocity (CR-PWV),carot-id-femoral pulse wave velocity (CF-PWV)], indexes of left ventricular remodeling [diastolic interventricular septum thickness (IVST),diastolic left ventricular posterior wall thickness(LPWT),left ventricular end diastolic diameter(LVIDd)] before and after treatment. The physiological function (PF),social function (SF),role-physical (RP),body pain (BP),mental health (MH),role-emotional(RE),vitality(VT)and general health(GH)score of SF-36 were observed in 2 groups before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:There was no statistical significance in total response rate be-tween 2 groups (P>0.05). There was no statistical significance in 24 hABP,CR-PWV,CF-PWV,IVST,LPWT,LVIDd,SF-36 score between 2 groups before treatment(P>0.05). After treatment,the levels of 24 hSBP,24 hDBP and 24 hMAP in 2 groups were decreased significantly,and 24 hSBP and 24 hMAP of observation groups were significantly lower than those of control group,with statistical significance (P<0.05). There was no statistical significance in 24 hDBP (P>0.05). The levels of CR-PWV,CF-PWV, IVST and LPWT in observation group were decreased significantly,and the levels of CR-PWV and LPWT in control group were also decreased significantly. The levels of CR-PWV,CF-PWV,IVST,LPWT and LVIDd in observation group were significantly lower than control group,with statistical significance (P<0.05). SF-36 scores of 2 groups were increased significantly,and the scores of BP,VT,MH and GH in observation group were significantly higher than control group,with statistical significance (P<0.05). There was no statistical significance in scores of PF,SF,RP and RE. There was no statistical significance in the incidence of ADR be-tween 2 groups(P>0.05). CONCLUSIONS:Felodipine sustained-release tablets(Ⅱ)exhibit significant effect and small blood pres-sure fluctuation in the treatment of elderly essential hypertension,and can improve the quality of life with good safety.