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 investigate the improving effect of nursing intervention based on Roy adaptation model on sleep condition of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods? A total of 118 patients with AECOPD admitted to Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University from July 2016 to May 2018 were selected by stratified sampling method. They were divided into observation group and control group according to random number table method, with 59 cases in each group. The control group was given conventional nursing care, while the observation group was given nursing intervention based on Roy adaptation model on the basis of the conventional nursing care. Before and after the intervention, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Social Support Rating Scale (SSRS), the Pittsburgh Sleep Quality Index (PSQI) were used to evaluate negative emotions, social support, sleep quality and quality of life of the patients. After the intervention, the nursing satisfaction of the two groups was compared. Results? After 2 weeks of intervention, the scores of SAS (26.33±4.72) and SDS (43.17±6.29) of the observation group were lower than those before intervention;the score of SSRS (34.21±6.95) was higher than that before intervention, and the observation group were all better than the control group, the differences were statistically significant (P＜ 0.05). After intervention, the PSQI scores of the observation group (5.01±1.27) and the control group (6.33±1.74) were statistically different (t=4.707, P＜0.05). The overall satisfaction of the patients in the observation group was 93.33% and that in the control group was 77.97%. There was a significant difference between the two groups (P＜ 0.05). Conclusions? Compared with conventional nursing, nursing intervention based on Roy adaptation model can better improve the negative emotions and social support of AECOPD patients, and improve sleep and nursing satisfaction.

Objective To investigate the pathogens distribution and their drug resistance of blood culture-positive neonates with sepsis in neonatal intensive care unit(NICU) and to provide evidence for clinically reasonable use of antibiotics.Methods One thousand four hundred and fifty neonates admitted to our NICU of Affiliated Hospital of Guangdong Medical College from Jan 2009 to Jul 2011 were enrolled.The blood samples from 1 450 neonates were cultured and isolated,and all of the isolates and their resistances were analyzed retrospectively.Results A total of 9 species and 233 pathogenic strains were isolated from 1 450 specimens,and the positive rate was 16.1％.Among the 233 strains,93 strains were gram-positive cocci,103 strains were gram-negative bacilli,and 37 strains were fungus.Among gram-positive cocci,the most dominant organism was coagulase negative staphylococcus,the next was Staphylococcus aureus;while among gram-negative bacilli,Ktebsiella pneumoniae were the most frequently isolated,the next were Escherichia coli and Acinetobacter baumannii,and among the fungus,monilia were the most isolated.The resistance rates of gram-positive cocci to vancomycin,linezolid and teicoplanin were high.Moreover,the antibiotic resistance rates to penicillin,oxazocilline and the β-lactamase were more than 95％.Gram-negative bacilli were sensitive to levofloxacin,imipenem and meropenem.A majority of fungus was Monilia,which was sensitive to antifungal.Conclusion Coagulase negative staphylococcus,Klebsiella pneumoniae and Escherichia coli are the the most common pathogens of neonatal sepsis in NICU,and have high drug resistance.Clinicians should select sensitive drug treatment according to bacterial identification and susceptibility testing.Besides,mycotic infection cannot be ignored and merit our attention.

5.0mg/L were randomly divided into LMWH treatment group and low molecular dextran treatment group with 20 patients in each group.The patients in LMWH group were treated with 0.3ml LMWH subcutaneous injection in abdominal wall in every 12h for 1-4 d.The patients in low molecular dextran group were treated with 500ml low molecular dextran plus 20ml danshen root,intervenous drop infusion for 1-7d.Results The D-Dimer blood serum level in the gestational late period was significantly higher than that of nongravida group(P