Objective To investigate the effect of toripalimab combined with chemoradiotherapy in patients with cervical lymph node metastasis of nasopharyngeal carcinoma on immune function.Methods A prospective study was conducted in 160 patients with nasopharyngeal carcinoma accom-panied by cervical lymph node metastasis.Patients were divided into study group and control group using block randomization,with 80 patients in each group.The control group received a standard che-moradiotherapy regimen,while the study group received toripalimab combined with chemoradiothera-py.Both groups were treated for 3 courses.The clinical efficacy,levels of immune function indica-tors,levels of tumor markers[squamous cell carcinoma antigen(SCC-Ag),high-mobility group box 1(HMGB1),pentraxin 3(PTX3),and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)],and the incidenceof adverse reactions were compared between the two groups.Results The objective re-sponse rates of the primary lesion and cervical lymph nodes in the study group were higher than those in the control group(P＜0.05).After treatment,the levels of CD3+,CD4+,and natural killer cells in the study group were higher than those before treatment and in the control group,while the lev-el of CD8+was lower than that before treatment and in the control group(P＜0.05).After treatment,the levels of HMGB1,PTX3,SCC-Ag and CYFRA21-1 in the study group were lower than those before treatment and in the control group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Toripalimab combined with chemoradiotherapy has a sig-nificant efficacy in treatment of cervical lymph node metastasis of nasopharyngeal carcinoma.It can enhance the immune function of patients,improve the levels of tumor markers,and has good safety.

In the field of healthcare service, it is crucial to optimize medical innovation services by combining the preferences of health service providers and demanders (i.e., stakeholders). The best-worst scaling (BWS) method is a recently developed stated preference method for assessing preferences with distinctive advantages. Nevertheless, there is a lack of a comprehensive introduction to stakeholder preference assessment using BWS, thus constraining its applications and promotion. This paper introduces the process of using BWS to assess service providers' preferences for the Shared Medical Appointment for diabetes (SMART), an integrated healthcare service of medicine and health management, in the hope of providing reference for researchers for promoting the use of BWS in implementation research.

OBJECTIVE：To study the mecha nism of Bambuterol hydrochloride in the improvement of chronic obstructive pulmonary disease （COPD）model rats ，and to find the potential biomarker. METHODS ：Totally 30 rats were randomly divided into normal group ，model group and bambuterol hydrochloride group （3.3 mg/kg），with 10 rats in each group ；COPD model was established by lipopolysaccharide （LPS）infusion combined with smoking in model group and bambuterol hydrochloride group. After modeling ，bambuterol hydrochloride group was given relevant medicine intragastrically ，normal group and model group were given constant volume of normal saline intragastrically ，once a day ，for consecutive 45 d. After last medication ，the serum sample and alveolar lavage fluid of rats were collected. The levels of interleukin- 6（IL-6）and tumor necrosis factor-α（TNF-α）in alveolar lavage fluid were detected by ELISA. The serum metabolites were detected by LC-MS and analyzed by metabolomics. Orthogonal partial least squares discriminant analysis （OPLS-DA）was used to screen out the differential metabolites. The potential biomarkers were identified based on the related literature ，and the metabolic pathway enrichment analysis was carried out by MetPA analysis platform. RESULTS ：Compared with normal group ，the levels of IL- 6 and TNF-α in alveolar lavage fluid of rats were increased significantly in model group （P＜0.05）. Compared with model group ，the levels of IL- 6 and TNF-α in alveolar lavage fluid of rats were decreased significantly in bambuterol hydrochloride group （P＜0.05）. Results of metabolomics and OPLS-DA showed that 21 differential metabolites and 12 potential biomarkers were found （including maleylpyruvate ， hydroxypyruvate， tartronate semialdehyde，etc.）. Bambuterol hydrochloride can significantly reduce the levels of maleylpyruvate ，methylselenocysteine and 5-deoxy-D-glucuronic acid （P＜0.05）， while increase the levels of hydroxypyruvate ， tartronate semialdehyde and. These biomarkers were mainly @163.com concentrated in pentose phosphoric acid pathway ，glyoxyli acid and tricarboxylic acid metabolism pathway ，followed by 开发。E-mail：pn333@163.com inositol phosphoric acid metabolism pathway ，arginine and tyrosine metabolism pathway ，glycine，serine and threonine metabolism pathway. CONCLUSIONS ：The mechanism of bambuterol hydrochloride improving COPD may be associated with the decrease of the levels of TNF-α and IL-6，as well as the pathway of amino acid metabolism ，energy metabolism and lipid metabolism.

Objective: To evaluate the effect of the standardized follow-up protocol based on telemedicine follow-up system in patients after mechanical heart valve replacement. Methods: A prospective, nonrandomized, controlled clinical trial was performed on 109 patients who underwent mechanical heart valve replacement in the Affiliated Hospital of North Sichuan Medical College from January 2017 to June 2017. They were divided into two groups according to patient's willingness, place of residence and whether have sufficient technical facilities (computer or mobile device connected to the internet), including 56 patients in the control group and 53 patients in the observation group. The control group received routine follow-up guidance, and the observation group received standardized follow-up protocol, which were followed up for 6 months. The patients in the two groups were analyzed with thromboembolism, hemorrhagic event and International normalized ratio (INR) related to anticoagulation therapy during the follow-up period, and the quality of early anticoagulation therapy was evaluated with Time in therapeutic range (TTR), and the satisfaction of the patients with anticoagulation therapy was investigated. Results: There was no significant difference in INR between the two groups during the follow-up period (P >0.05). The TTR of the control group and the observation group was 44.6% (4 516.6 d/10 127.0d) and 54.1% (5 576.1d/10 307 d), respectively, with statistically significant differences (t=-11.273, P < 0.05).There were no significant differences between the two groups in the anticoagulant complications, thromboembolism, hemorrhagic events (P > 0.05). There was significant difference between the observation group and the control group in overall satisfaction with anticoagulation therapy and helpful in answering the patients' questions (Z=6.42, 5.62, P < 0.05), while no statistically significant difference in service attitude to the follow-up period and satisfaction with the guidance that was provided (P > 0.05). Conclusion Standardized follow-up protocol based on telemedicine follow-up system is applied to patients after MHVR surgery, which is conducive to improving the quality of anticoagulant therapy and improving the satisfaction of patients, and providing reference for the development of "Internet + medical" mode in China.

By reviewing the domestic and international relevant literature on the anticoagulant therapy for patients on oral warfarin, the patients' compliance status of their therapeutic regime and new anticoagulant management approaches overseas are summarized to explore the suitable anticoagulant therapy management modal for our country.