BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of subsequent radiotherapy (RT) following first-line treatment with durvalumab plus chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC). METHODS: A total of 122 patients with ES-SCLC from three hospitals during July 2019 to December 2021 were retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to address potential confounding factors. The primary focus of our evaluation was to assess the impact of RT on progression-free survival (PFS) and overall survival (OS). RESULTS: After IPTW analysis, 49 patients received durvalumab plus platinum-etoposide (EP) chemotherapy followed by RT (Durva + EP + RT) and 72 patients received immunochemotherapy (Durva + EP). The median OS was 17.2 months vs . 12.3 months (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.17-0.85, P = 0.020), and the median PFS was 8.9 months vs . 5.9 months (HR: 0.56, 95% CI: 0.32-0.97, P = 0.030) in Durva + EP + RT and Durva + EP groups, respectively. Thoracic radiation therapy (TRT) resulted in longer OS (17.2 months vs . 14.7 months) and PFS (9.1 months vs . 7.2 months) compared to RT directed to other metastatic sites. Among patients with oligo-metastasis, RT also showed significant benefits, with a median OS of 17.4 months vs . 13.7 months and median PFS of 9.8 months vs . 5.9 months compared to no RT. Continuous durvalumab treatment beyond progression (TBP) prolonged OS compared to patients without TBP, in both the Durva + EP + RT (NA vs . 15.8 months, HR: 0.48, 95% CI: 0.14-1.63, P = 0.238) and Durva + EP groups (12.3 months vs . 4.3 months, HR: 0.29, 95% CI: 0.10-0.81, P = 0.018). Grade 3 or 4 adverse events occurred in 13 (26.5%) and 13 (18.1%) patients, respectively, in the two groups; pneumonitis was mostly low-grade. CONCLUSION Addition of RT after first-line immunochemotherapy significantly improved survival outcomes with manageable toxicity in ES-SCLC.
Humans ; Small Cell Lung Carcinoma/therapy* ; Retrospective Studies ; Male ; Female ; Middle Aged ; Lung Neoplasms/therapy* ; Aged ; Antibodies, Monoclonal/therapeutic use* ; Adult ; Immunotherapy/methods* ; Aged, 80 and over

Objective To study the effects of simple portal hypertension on the endotoxin levels in serum and intestinal mucosa of rats. Methods A total of 16 rats were divided into the blank control group (4 rats) and the model groups (3-day group, 7-day group and 10-day group, 4 rats in each group). The rat model of partial portal vein ligation was established in the model groups, and samples of blood and jejunum, ileum and colon of the rats were taken on the 3rd, 7th and 10th days, respectively. Changes in the serum endotoxin levels were detected by ELISA. Histopathological changes of the intestinal tissues were examined by HE staining. Results The rat model of partial portal vein ligation was successfully established in all the model groups. The serum levels of endotoxin on the 3rd, 7th and 10th days in the model groups were not significantly different from that in the normal control group. Damages of different intestinal segments were not serious on the 3rd day after modeling. However, on the 7th day after modeling, there were some sowllen and damaged intestinal villi in the intestinal mucosa of each intestinal segment, and the connection between the epithelial cells and the lamina propria was broken, compared with that at 3 days after modeling. In addition, there were obvious damages in the intestinal mucosa and lamina propria on the 10th day, compared with that at 3 d and 7 d after modeling. Conclusions In the case of normal liver function, portal hypertension can cause intestinal mucosal damages within a short period of time, but the amount of endotoxin produced by intestine does not exceed the processing capacity of the liver and thus does not cause an increase in the serum endotoxin level.

Objective To investigate the potential roles of 14 -3 -3 in the pathogenesis of the cervical cancer.Methods Tissues from 107 patients with cervical cancer(cervical cancer group),50 cases of cervical intra-epithelial neoplasia (cervical intraepithelial neoplasia group)and 50 cases of chronic cervicitis (chronic cervicitis group)were obtained.Immunohistochemistry was performed to determine the expression of 14 -3 -3 protein in tissues of the three groups.Results The positive rate of 14 -3 -3 in cervical cancer group(75.70%)was signifi-cantly higher than that in cervical intraepithelial neoplasia group and chronic cervicitis group(42.00%,30.00%, respectively)(χ2 =17.00,29.96,all P <0.01),while there was no significant difference of 14 -3 -3 level between the cervical intraepithelial neoplasia group and chronic cervicitis group(χ2 =1.56,P >0.05).Moreover,in the cervi-cal cancer group,the positive rate of 14 -3 -3 in lymph node metastasis group was 88.89%,which was higher than that in negative lymph node metastasis group (63.16%)(χ2 =5.15,P <0.05).Conclusion The expression level of 14 -3 -3 protein in cervical cancer is increased,it may be correlated with cervical cancer cell malignant differenti-ation and metastasis.Perhaps,14 -3 -3 will play a key role as a novel target for tumor therapy.

Objective To discuss the correlation between nutritional megaloblastic anemia and homocysteine,in order that e-valuate the application of homocysteine in some aspects that detection and treatment of megaloblatic anemia.Methods The study was divided into three groups,included case group (MA group,n=192,including megaloblatic anemia of vitamin B12 deficiency,n=60;megaloblatic anemia of folic acid deficiency,n=69;megaloblatic anemia of folic acid and vitamin B12 defi-ciency,n=63),matched group (heathy persons,n=200)and treated group (persons who recovered from megaloblatic ane-mia,n=192).Results The difference on homolevel in plasma between case group and matched group had statistical sidnifi-cance (t=3.56,3.21,2.78,P <0.01).The difference on homocysteine level in plasma between treated group and matched group had no statistical sidnificance (t=1.23,0.98,0.77,P >0.05).The Hcy levels of folic acid deficiency vitamin B12 de-ficiency,vitamin B12 deficiency and folic acid and vitamin B12 deficiency had no statistical sidnificance (t=1.42,P >0.05). Conclusion The homocysteine level of patients who had nutritional megaloblatic anemia higher than heathy persons.High level of homocysteine had correction between the nutritional megaloblatic anemia.The lack of some nutrition facters (eg:fo-lic acid,vitamin B12)can lead to high homocysteine disease.Detecting the change of homocysteine level in plasma can guide the treatment of nutritional megaloblatic anemia.

Objective The study systematically reviewed the therapeutic effect of the Kidney-Nourishing therapy on aromatase inhibitor-associated bone loss (AIBL).Methods The databases CNKI, CBM, VIP, Medline and the Cochrane Library were searched. Cochrane collaboration's tool for assessing risk of bias was adopted to assess the quality of trials. The Revman 5.3 software was used for the analysis on the outcome index such as bone minernal density and the level of serum estradiol.Results Meta-analysis was conducted on 11 randomly controlled clinical trials. All 11 studies were concducted in China, and the quality of researches was low. Meta-analysis revealed that the decrement of bone mineral density in the group receiving kidney-nourishing herbs was significantly smaller than that in the control group(P<0.001), theMD was -0.070, 95%CI was (-0.087, -0.053), but there was no significant difference between two groups in the outcome of the serum estradiol level (P=0.159), theMD was -2.622, 95%CIwas(-6.273, 1.030).Conclusion Kidney- Nourishing herbs can delay the process of aromatase inhibitor-associated bone loss, but may not influence the serum estrogen level.