OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors （ICIs） combined with neoadjuvant chemotherapy in the treatment of early triple-negative breast cancer （TNBC）. METHODS Randomized controlled trials （RCTs） comparing ICIs combined with neoadjuvant chemotherapy （experimental group） versus neoadjuvant chemotherapy alone （control group） were retrieved from PubMed， Cochrane Library， Embase， Web of Science， CNKI， Wanfang Data， and VIP databases， as well as relevant studies published at oncology academic conferences. The search period was from database inception to June 30， 2025. After literature screening， data extraction， and quality assessment， a meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 6 RCTs involving 3 786 patients were finally included. The meta-analysis results showed that the experimental group had superior event-free survival [HR＝0.73， 95%CI （0.62， 0.85）， P＜0.000 1]， overall survival [HR＝0.69， 95%CI （0.57， 0.84）， P＝0.000 3]， and pathological complete response （pCR） [OR＝1.57， 95%CI （1.37， 1.80）， P＜0.000 01] compared to the control group. The incidence of ≥grade 3 adverse event （AE）， severe AE （SAE）， and ≥ grade 3 immune-related adverse event （irAE） in the experimental group was significantly higher than that in the control group. There was no statistically significant difference between the two groups in the incidence of any AE or any irAE （P＞0.05）. Subgroup analysis revealed that， regardless of programmed cell death ligand 1 expression status （negative or positive），the pCR in the experimental group was significantly higher than that in the control group （P＜0.05）. Additionally， the pCR of the patients with positive lymph nodes in the experimental group was significantly higher to that in the ontrol group （P＜0.05）. There was no statistically significant difference in pCR between the two groups with negative lymph nodes （P＝0.09）. CONCLUSIONS ICIs combined with neoadjuvant chemotherapy can significantly improve event-free survival and overall survival in patients with TNBC， providing patients with long-term survival benefits. However， the risk of ≥ grade 3 AE， SAE and ≥ grade 3 irAE has increased.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

OBJECTIVE To construct a predictive tool for surgical site infections(SSIs)in spinal surgery for Chi-nese population to provide evidence support for reducing SSIs.METHODS A systematic review of Chinese and English database literature was conducted for Meta-analysis to obtain pooled risk values for influencing factors,and a risk prediction scoring tool was constructed based on the logistic regression model.Patients who underwent spinal surgery and completed postoperative follow-up in a tertiary hospital in Beijing from Jan.to Dec.2021 were selected to validate the predictive effect of the tool.RESULTS The predictive model for SSIs in Chinese spinal sur-gery patients was Logit(P)=—3.47+0.63(age 60 years)+0.31 ×(patient with cardiovascular disease)+0.69 ×(rheumatoid arthritis)+1.07 ×(diabetes)+1.06 ×(operation duration＞3 h)+1.17 ×(preopera-tive albumin＜35 g/L)+0.71 ×(history of spinal surgery)+0.67 ×(carrying internal implants)+0.73 ×(blood transfusion).The total score of the predictive tool was 92,with a cutoff score of≥24.50 indicating high-risk individuals.The area under the curve was 0.733,with the sensitivity 58.30％and the specificity 79.60％.CONCLUSION The established predictive model for SSIs in Chinese spine surgery demonstrates good predictive performance and can be used as a reference assessment tool in clinical practice.

Objective To evaluate the safety and efficacy of ciprofol in the anesthesia of elderly patients undergoing bronchoscopy.Methods A total of 96 elderly patients(≥65 years old)undergoing fiberoptic bronchos-copy under sedation and anesthesia were randomly assigned to either the ciprofol group(Group C,n=48)or the propofol group(Group P,n=48).In Group C,anesthesia was induced with an intravenous injection of sufentanil at 0.1 μg/kg and ciprofol at 0.3 mg/kg.In Group P,anesthesia was induced with an intravenous injection of sufent-anil at 0.1 μg/kg and propofol medium/long-chain fat emulsion at 1.5 mg/kg.Hemodynamic parameters,including heart rate(HR),mean arterial pressure(MAP),and peripheral oxygen saturation(SpO2),were recorded at five time points:before anesthesia induction(T1),immediately after the bronchoscope passed through the glottis(T2),immediately after it reached the carina(T3),immediately after the bronchoscope was withdrawn from the nostril post-procedure(T4),and upon full consciousness after leaving the recovery room(T5).Additionally,the success rate of sedation and anesthesia,cough severity scores,induction time(t1),bronchoscopy duration(t2),recovery time(t3),and orientation recovery time(t4)were documented for both groups.Intraoperative complications,such as hypotension,hypoxemia(SpO2<90%),injection pain during induction,airway interventions(e.g.,jaw support,mask ventilation),and the number of additional sedative doses administered,were also recorded.Results Compared with T1,MAP in both groups decreased at T2 and T3(P<0.05).Compared with group P,group C exhibited a higher MAP at T2 and T3(P<0.05).between the two groups in terms of sedation success rate,induction time,cough score,examination time,recovery time,and orientation recovery time(P>0.05).Compared with group P,group C demonstrated lower incidences of hypotension,hypoxemia,injection pain,and fewer airway intervention events(P<0.05).Conclusions Compared with propofol,ciprofol in combination with sufentanil demonstrates superior circulatory stability,a lower incidence of respiratory system-related adverse reactions,and reduced injection pain.Therefore,it can be safely and effectively utilized for painless bronchoscopic diagnosis and treatment in elderly patients.

Objective:To investigate the protective effect of fluoxetine on neurons in rats with subarachnoid hemorrhage (SAH) and explore its mechanism based on the chemokine receptor 4 (CXCR4)/nucleotide-binding oligomerization domain-like receptor protein 1 (NLRP1) pathway.Methods:Seventy-five rats were randomly divided into a normal control group and a model group. The SAH model was established by the internal carotid artery puncture method in the model group. After modeling, rats were randomly divided into the model group, fluoxetine low-, medium-, and high-dose groups, and nimodipine group, with 12 rats in each group. The fluoxetine low-, medium-, and high-dose groups were intravenously injected with fluoxetine at doses of 5, 10, and 15 mg/kg, respectively; the nimodipine group was intraperitoneally injected with nimodipine at 0.2 mg/kg; the normal control group and model group were intraperitoneally injected with an equal volume of normal saline, once a day for 7 consecutive days. The shuttle box was used to determine the number of avoidance responses and avoidance response time of rats. The water content of brain tissue and Evans blue exudation volume were calculated. Enzyme-linked immunosorbent assay (ELISA) kits were used to detect the levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) in the hippocampal tissue. Hematoxylin-eosin (HE) staining was used to observe the pathological changes of hippocampal tissue. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the mRNA levels of CXCR4 and NLRP1 in the hippocampal tissue. Western blot was used to determine the protein levels of CXCR4, NLRP1, LC3-Ⅱ, and Beclin1 in the hippocampal tissue.Results:Compared with the normal control group, the model group had a lower number of avoidance responses, lower levels of SOD, CAT, GSH, CXCR4 mRNA, CXCR4, LC3-Ⅱ, and Beclin1 protein in the hippocampal tissue (all P<0.05); while the avoidance response time, brain water content, Evans blue exudation volume, levels of IL-6, TNF-α, MDA, and mRNA and protein levels of NLRP1 in the hippocampal tissue were higher (all P<0.05). Compared with the model group, the fluoxetine groups (all doses) and nimodipine group had a higher number of avoidance responses, higher levels of SOD, CAT, GSH, CXCR4 mRNA, CXCR4, LC3-Ⅱ, and Beclin1 protein in the hippocampal tissue (all P<0.05); while the avoidance response time, brain water content, Evans blue exudation volume, levels of IL-6, TNF-α, MDA, and mRNA and protein levels of NLRP1 in the hippocampal tissue were lower (all P<0.05); moreover, the changes in various indicators were more significant with the increase of fluoxetine dose. HE staining results showed that there were no pathological changes in the hippocampal tissue of the normal control group; in the model group, the number of hippocampal neurons decreased, nuclei were pycnotic, and cell arrangement was irregular. Compared with the model group, the number of hippocampal neurons increased, cell arrangement was regular, and hippocampal pathology was significantly restored in the fluoxetine groups (all doses) and nimodipine group. Conclusions:Fluoxetine can significantly alleviate the pathological progression of cerebral edema, repair neuronal damage, improve neurological function, and regulate mitochondrial autophagy in SAH rats, whose mechanism may be related to the regulation of the CXCR4/NLRP1 pathway.

OBJECTIVE To evaluate the efficacy and safety of three aromatase inhibitors(exemestane,anastrozole,letrozole)for postmenopausal hormone receptor(HR)-positive early breast cancer.METHODS PubMed,the Cochrane Library,Embase,CNKI,Wanfang Data,VIP and SinoMed were searched to collect randomized controlled trials(RCTs)of the above three drugs in the treatment of postmenopausal HR-positive early breast cancer patients.The retrieval time limit was from the establishment of the database to October 25,2024.After literature screening,data extraction and literature quality evaluation,network meta-analysis was performed by using RevMan 5.3 and Stata 18.0 software.RESULTS A total of 15 RCTs involving 44 055 patients were included.The results of network meta-analysis showed that the objective response rate of letrozole group was significantly higher than anastrozole group(P＜0.05),and the order of surface under the cumulative ranking curve(SUCRA)from high to low was letrozole(85.6%)＞anastrozole(61.5%)＞exemestane(2.8%).The disease-free survival rate of anastrozole group was significantly higher than exemestane and placebo groups(P＜0.05),and the order of SUCRA from high to low was letrozole(85.8%)＞anastrozole(67.3%)＞exemestane(41.4%)＞placebo(5.5%).The total incidence of adverse reactions in anastrozole group was significantly higher than letrozole and placebo groups(P＜0.05),and the order of SUCRA from high to low was exemestane(87.4%)＞letrozole(63.9%)＞anastrozole(47.0%)＞placebo(1.7%).The results of subgroup analysis according to the course of treatment≥104 weeks were consistent with them.CONCLUSIONS Compared with anastrozole,letrozole has better efficacy and safety in the treatment of postmenopausal HR-positive early breast cancer,and the efficacy of exemestane is limited.

Inappropriate polypharmacy is common in older patients with co-morbidities, and prescription streamlining can help to ensure the safety of medications for older patients with co-morbidities.In 2023, The Alliance of European Geriatrics Societies(AEGS)summarized the literature on medication review and prescription streamlining to propose 33 recommendations for optimizing polypharmacy and prescription streamlining in older patients with co-morbidities.The strategy suggests incorporating prescription streamlining into the daily practice of geriatricians and clinical pharmacists, and provides recommendations about education and training of clinical staff, development of disease guidelines, policy support, and clinical trial research in older adults aiming to improve the management of polypharmacy.This article explains the key elements of this strategy to provide reference for high-quality healthcare for elderly patients with co-morbid in China.

Left ventricular pseudoaneurysm(LVPA) is a rare type of abnormal ventricular wall bulge formed by injury to the inner wall of the left ventricle. The exterior wall only consists of epicardium or/and pericardium. In a systematic literature review, myocardial infarction(55%), surgery(33%), and trauma(7%) are the top three associations. Being affected by the high pressure of the left ventricle, LVPA has the risk of enlargement and rupture, which can lead to sudden death. The treatment of LVPA consists of three main modalities: medication, surgery, and transcatheter closure. In the past, surgery was the preferred treatment for LVPA, but the surgery was highly invasive, traumatic, and associated with increased risks. In recent years, transcatheter closure has been developed and applied clinically with good results. The benefits of minimal invasiveness and quick recovery have emerged as a popular treatment for LVPA. Currently, the etiology, formation, and treatment of LVPA are not clearly defined. Large-sample studies and authoritative guidelines to guide the treatment are scarce. The timing, imaging modality, and access routes to LVPA for both surgery and transcatheter closure are still controversial. In this article, we review the relevant literatures and draw the following conclusions as: (1) Diagnostic workup is essential for anatomical characterization of LVPA, which is mandatory to guide the decision on surgical methods.(2) For a subset of patients with LVPA and a well-defined fibrotic neck, and deemed at high surgical risk, transcatheter closure of the cavity has been described with encouraging results.

Objective:To assess the efficacy and safety profile of antaitasvir phosphate combined with yiqibuvir in the treatment of chronic hepatitis C (CHC) of various genotypes, without cirrhosis or with compensated cirrhosis.Methods:394 cases with CHC from 22 centers were collected from October 2021 to April 2023. They were randomly assigned to receive either the experimental drugs (antaitasvir phosphate 100 mg+yiqibuvir 600 mg) or placebo treatment in a 3∶1 ratio. The patients were administered drugs once a day for 12 consecutive weeks, and then followed up for 24 weeks after treatment cessation. All subjects were unblinded at the four-week follow-up following drug discontinuation, with the experimental drug group continuing to complete subsequent post-discontinuation follow-up. The placebo group was switched to receive the experimental drugs for a repeated 12-week treatment period and followed up for another 24 weeks after discontinuation of the drug (placebo delayed treatment phase).The sustained virologic response rate (SVR12) was observed for subjects in the double-blind phase and the placebo delayed-treatment phase at 12 weeks after treatment cessation.Virological resistance analysis was performed on subjects who failed treatment. The primary efficacy endpoint was SVR12. The number and percentage of subjects who achieved "HCV RNA

Objective To evaluate the safety and efficacy of ciprofol in the anesthesia of elderly patients undergoing bronchoscopy.Methods A total of 96 elderly patients(≥65 years old)undergoing fiberoptic bronchos-copy under sedation and anesthesia were randomly assigned to either the ciprofol group(Group C,n=48)or the propofol group(Group P,n=48).In Group C,anesthesia was induced with an intravenous injection of sufentanil at 0.1 μg/kg and ciprofol at 0.3 mg/kg.In Group P,anesthesia was induced with an intravenous injection of sufent-anil at 0.1 μg/kg and propofol medium/long-chain fat emulsion at 1.5 mg/kg.Hemodynamic parameters,including heart rate(HR),mean arterial pressure(MAP),and peripheral oxygen saturation(SpO2),were recorded at five time points:before anesthesia induction(T1),immediately after the bronchoscope passed through the glottis(T2),immediately after it reached the carina(T3),immediately after the bronchoscope was withdrawn from the nostril post-procedure(T4),and upon full consciousness after leaving the recovery room(T5).Additionally,the success rate of sedation and anesthesia,cough severity scores,induction time(t1),bronchoscopy duration(t2),recovery time(t3),and orientation recovery time(t4)were documented for both groups.Intraoperative complications,such as hypotension,hypoxemia(SpO2<90%),injection pain during induction,airway interventions(e.g.,jaw support,mask ventilation),and the number of additional sedative doses administered,were also recorded.Results Compared with T1,MAP in both groups decreased at T2 and T3(P<0.05).Compared with group P,group C exhibited a higher MAP at T2 and T3(P<0.05).between the two groups in terms of sedation success rate,induction time,cough score,examination time,recovery time,and orientation recovery time(P>0.05).Compared with group P,group C demonstrated lower incidences of hypotension,hypoxemia,injection pain,and fewer airway intervention events(P<0.05).Conclusions Compared with propofol,ciprofol in combination with sufentanil demonstrates superior circulatory stability,a lower incidence of respiratory system-related adverse reactions,and reduced injection pain.Therefore,it can be safely and effectively utilized for painless bronchoscopic diagnosis and treatment in elderly patients.