Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack. For patients with atherosclerotic stroke, it is recommended to use high-intensity statins, cholesterol absorption inhibitors and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors for lipid-lowering treatment. This article reviews the current roles of statins and PCSK9 inhibitors in lowering lipids, reducing ischemic events, reducing the degree of vascular stenosis and the effect on atherosclerotic plaque in patients with symptomatic ICAS.

Objective To explore the relationship between the triglyceride glucose(TyG)index and 2-year cognitive function changes.Methods A total of 101 elderly patients who were hospitalized at Quanzhou First Hospital Affiliated to Fujian Medical University from September to December 2022 were selected.The cognitive function was evaluated using Montreal cognitive assessment(MoCA)scale.According to the baseline TyG index,the subjects were divided into high TyG index group(TyG index≥ 8.79,51 cases)and low TyG index group(TyG index＜8.79,50 cases).Using a binary Logistic regression model to adjust for confounding factors,the association between TyG index and cognitive decline was analyzed.Results The Spearman correlation analysis results showed that TyG index was negatively correlated with the change value of cognitive function(r=-0.243,P＜0.05).The incidence of cognitive function decline in high TyG index group was significantly higher than that in low TyG index group(43.1％vs.24.0％,P=0.042).After adjusting for confounding factors,the risk of cognitive function decline in high TyG index group was 2.971 times that of low TyG index group(P＜0.05).Conclusion The TyG index of elderly hospitalized patients is correlated with 2-year cognitive function changes.The TyG index may serve as a potential biomarker for early detection of cognitive function decline.

Objective To explore the effect of low density lipoprotein-cholesterol(LDL-C)on the diameters of retinal arteries and veins in patients with type 2 diabetes mellitus(T2DM).Methods A total of 102 patients with T2DM who treated in Quanzhou First Hospital Affiliated to Fujian Medical University from January to September 2024 were selected and divided into Group A(LDL-C＜2.6mmol/L,35 cases),Group B(2.6mmol/L≤LDL-C＜3.4mmol/L,33 cases)and Group C(LDL-C≥3.4mmol/L,34 cases)according to the LDL-C level.The clinical data and color fundus photos of the patients were collected.The superior temporal retinal arteriolar equivalent(RAE)and superior temporal retinal venular equivalent(RVE)in the left eye of patients were measured,and the ratio of arteriovenous diameters(AVR)was calculated.The correlation between LDL-C levels and retinal vascular diameters was analyzed.Results There were statistically significant differences in levels of total cholesterol and triglycerides,as well as the proportions of patients with coronary heart disease and diabetic retinopathy(DR)among the three groups(P＜0.05).With the progression of DR,the level of LDL-C gradually increases(P＜0.05).There were statistically significant differences in RAE and AVR among patients with different DR stages(P＜0.05).There were statistically significant differences in RAE and AVR among three groups of patients(P＜0.05).Correlation analysis showed that RAE and AVR were negatively correlated with LDL-C(P＜0.05).Conclusion With the increase of LDL-C level,the degree of DR aggravates,and RAE and AVR decrease accordingly.However,there is no significant correlation between LDL-C and RVE.

Objective To explore the relationship between the triglyceride glucose(TyG)index and 2-year cognitive function changes.Methods A total of 101 elderly patients who were hospitalized at Quanzhou First Hospital Affiliated to Fujian Medical University from September to December 2022 were selected.The cognitive function was evaluated using Montreal cognitive assessment(MoCA)scale.According to the baseline TyG index,the subjects were divided into high TyG index group(TyG index≥ 8.79,51 cases)and low TyG index group(TyG index＜8.79,50 cases).Using a binary Logistic regression model to adjust for confounding factors,the association between TyG index and cognitive decline was analyzed.Results The Spearman correlation analysis results showed that TyG index was negatively correlated with the change value of cognitive function(r=-0.243,P＜0.05).The incidence of cognitive function decline in high TyG index group was significantly higher than that in low TyG index group(43.1％vs.24.0％,P=0.042).After adjusting for confounding factors,the risk of cognitive function decline in high TyG index group was 2.971 times that of low TyG index group(P＜0.05).Conclusion The TyG index of elderly hospitalized patients is correlated with 2-year cognitive function changes.The TyG index may serve as a potential biomarker for early detection of cognitive function decline.

Objective To explore the effect of low density lipoprotein-cholesterol(LDL-C)on the diameters of retinal arteries and veins in patients with type 2 diabetes mellitus(T2DM).Methods A total of 102 patients with T2DM who treated in Quanzhou First Hospital Affiliated to Fujian Medical University from January to September 2024 were selected and divided into Group A(LDL-C＜2.6mmol/L,35 cases),Group B(2.6mmol/L≤LDL-C＜3.4mmol/L,33 cases)and Group C(LDL-C≥3.4mmol/L,34 cases)according to the LDL-C level.The clinical data and color fundus photos of the patients were collected.The superior temporal retinal arteriolar equivalent(RAE)and superior temporal retinal venular equivalent(RVE)in the left eye of patients were measured,and the ratio of arteriovenous diameters(AVR)was calculated.The correlation between LDL-C levels and retinal vascular diameters was analyzed.Results There were statistically significant differences in levels of total cholesterol and triglycerides,as well as the proportions of patients with coronary heart disease and diabetic retinopathy(DR)among the three groups(P＜0.05).With the progression of DR,the level of LDL-C gradually increases(P＜0.05).There were statistically significant differences in RAE and AVR among patients with different DR stages(P＜0.05).There were statistically significant differences in RAE and AVR among three groups of patients(P＜0.05).Correlation analysis showed that RAE and AVR were negatively correlated with LDL-C(P＜0.05).Conclusion With the increase of LDL-C level,the degree of DR aggravates,and RAE and AVR decrease accordingly.However,there is no significant correlation between LDL-C and RVE.

Background and purpose:For patients with human epidermal growth factor receptor 2(HER2)-positive metastatic breast cancer,trastuzumab treatment can prolong the overall survival and significantly improve the prognosis of patients.However,the reference original research trastuzumab(Herceptin?)is more expensive.Biosimilars have comparable efficacy and safety profiles while increasing patient access to treatment.This clinical trial aimed to evaluate the efficacy,pharmacokinetics,safety and immunogenicity of the trastuzumab biosimilar AK-HER2 compared to trastuzumab(Herceptin?)in patients with HER2-positive metastatic breast cancer.Methods:This multi-center,randomised,double-blind phase Ⅲ clinical trial was conducted in 43 subcenters in China.This study complied with the research protocol,the ethical principles stated in the Declaration of Helsinki and the quality management standards for drug clinical trials.It was approved by the hospital's medical ethics committee.The clinical trial registration agency is the State Food and Drug Administration(clinical trial approval number:2015L04224;clinical trial registration number:CTR20170516).Written informed consent was obtained from subjects before enrollment.Enrolled patients were randomly assigned to the AK-HER2 group and the control group,respectively receiving AK-HER2 or trastuzumab(initial loading dose 8 mg/kg,maintenance dose 6 mg/kg,every 3 weeks as a treatment cycle,total treatment time is 16 cycles)in combination with docetaxel(75 mg/m2,treatment duration is at least 9 cycles).The primary endpoint of this clinical trial was the objective response rate(ORR9)between the AK-HER2 group and the control group in the 9th cycle.Secondary efficacy endpoints included ORR16,disease control rate(DCR),clinical benefit rate(CBR),progression-free survival(PFS)and 1-year survival rate.In this study,100 subjects(AK-HER2 group to control group=1:1)were randomly selected for blood sample collection after the 6th cycle of medication,The collection time points were 45 minutes after infusion(the end of administration),4,8,24,72,120,168,336,and 504 hours after the end of administration.After collection,blood samples were analyzed by PK parameter set(PKPS).Other evaluation parameters included safety and immunogenicity assessment.Results:A total of 550 patients with HER2-positive metastatic breast cancer were enrolled in this clinical trial between Sep.2017 and Mar.2021.In the AK-HER2 group(n=237),129 subjects in the experimental group achieved complete response(CR)or partial response(PR),and the ORR9 was 54.4%.There were 134 subjects in the control group(n=241)who achieved CR or PR,and the ORR9 was 55.6%.The ORR9 ratio between the AK-HER2 group and the control group was 97.9%[90%confidence interval(CI):85.4%-112.2%,P=0.784],which was not statistically significant.In all secondary efficacy endpoints,no statistically significant differences were observed between the two groups.We conducted a mean ratio analysis of pharmacokinetics(PK)parameters between the AK-HER2 group and the control group,and the results suggested that the pharmacokinetic characteristics of the two drugs are similar.The incidence of treatment emergent adverse event(TEAE)leading to drug reduction or suspension during trastuzumab treatment was 3.6%(10 cases)in the AK-HER2 group and 8.1%(22 cases)in the control group.There was statistically significant difference between the two groups(P=0.027).The incidence rate was significantly lower in the AK-HER2 group than in the control group,and there was no statistically significant difference among the other groups.The differences in the positive rates of anti-drug antibodies(ADA)and neutralizing antibodies(NAB)between groups were of no statistical significance(P=0.385 and P=0.752).Conclusion:In patients with HER2-positive metastatic breast cancer,AK-HER2 was comparable to the trastuzumab(Herceptin?)in terms of drug efficacy,pharmacokinetics,safety and immunogenicity.

Abstract Social network of adolescents is one of the important factors affecting the initiation and development of their unhealthy eating behaviors, and different types of social networks shows varied influences on adolescents eating behaviors through divergent mechanisms. In the context of the new media era, social networks of adolescents establish via social media appear more complex and extensive. Based on relevant previous literature, the paper explores the impact and possible mechanisms of social network on eating behavior of adolescents, as well as its development and application in the new media era to provide references for better intervention strategies and healthier eating behaviors among adolescents from the perspective of social network.

Entinostat plus exemestane in hormone receptor-positive (HR+) advanced breast cancer (ABC) previously showed encouraging outcomes. This multicenter phase 3 trial evaluated the efficacy and safety of entinostat plus exemestane in Chinese patients with HR + ABC that relapsed/progressed after ≥1 endocrine therapy. Patients were randomized (2:1) to oral exemestane 25 mg/day plus entinostat (n = 235) or placebo (n = 119) 5 mg/week in 28-day cycles. The primary endpoint was the independent radiographic committee (IRC)-assessed progression-free survival (PFS). The median age was 52 (range, 28-75) years and 222 (62.7%) patients were postmenopausal. CDK4/6 inhibitors and fulvestrant were previously used in 23 (6.5%) and 92 (26.0%) patients, respectively. The baseline characteristics were comparable between the entinostat and placebo groups. The median PFS was 6.32 (95% CI, 5.30-9.11) and 3.72 (95% CI, 1.91-5.49) months in the entinostat and placebo groups (HR, 0.76; 95% CI, 0.58-0.98; P = 0.046), respectively. Grade ≥3 adverse events (AEs) occurred in 154 (65.5%) patients in the entinostat group versus 23 (19.3%) in the placebo group, and the most common grade ≥3 treatment-related AEs were neutropenia [103 (43.8%)], thrombocytopenia [20 (8.5%)], and leucopenia [15 (6.4%)]. Entinostat plus exemestane significantly improved PFS compared with exemestane, with generally manageable toxicities in HR + ABC (ClinicalTrials.gov #NCT03538171).

Under the background of efficiency medical reform, the authors introduced the nursing efficiency management system of a large public hospital, which was divided into two dimensions: nursing resource allocation efficiency and nursing service efficiency. The specific four measures included the establishment of multi-campus unified management organization structure based on nursing management committee, nursing performance reform based on structured big data information platform, the construction of nurse-led patient whole process management model and the accelerated rehabilitation nursing practice from surgery to the whole hospital, so as to provide reference for the nursing efficiency management of large general public hospitals under the medical reform.

Objective:To observe the effect of evidence-based early activity training on postoperative delirium in patients with brain tumor resection.Methods:This study used non-contemporary comparison method, a total of 238 patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in 2019, were included. 121 patients who met the inclusion criteria and signed informed consent after craniotomy during January 1st,2019 to June 31th,2019 were included in the control group, and 117 patients who met the criteria and obtained informed consent after craniotomy during July 1 to December 31,2019, were included in the experimental group. Neurosurgical postoperative routine nursing care were given to the control group. The experimental group received evidence-based early activity training. The incidence of delirium, duration of delirium, Barthel Index (BI), delirium-related adverse events and other indicators of postoperative hospitalization were compared between two groups.Results:The incidence of delirium, duration of delirium and postoperative hospital stay in the experimental group were 9.5%, 2.0 (1,3) days and 7 (5,10) days, lower than 23.3%, 3.0 (1,5) days and 8 (6,11) days in control group, and the differences were statistically significant ( χ2 value was 8.17, Z value were 2.96 and -2.01, P<0.05). BI index 1 week and 1 month after discharge in the experimental group was 90 (85, 90), 100 (100, 100), higher than the control group of 90 (86, 90) and 100 (100,100), with statistically significant difference ( Z values were -2.41 and -2.46, P<0.05), the comparison of adverse events, 0 case in experimental group, 1 case in control group, there was no statistically significant difference ( χ2 value was 0.97, P>0.05). Conclusions:Early evidence-based activities in patients with brain tumor resection can reduce the incidence of postoperative delirium, shorten the duration of postoperative delirium and postoperative hospital stay, and improve the ability of patients to take care of themselves after surgery, which is safe and effective.