Objective : To analyze the current status of anti-PD-1 combined with chemotherapy in advanced gastric cancer. Methods: The clinical data of 120 patients with advanced gastric cancer treated with chemotherapy or anti-PD-1 plus chemotherapy were retrospectively analyzed. The efficacy [measures include objective response rate(ORR), disease control rate(DCR), and progression-free survival(PFS)]and the occurrence of adverse reactions in patients was monitored. Univariate and multivariate Cox were used to analyze the relationship between clinicopathologic data [including age, gender, body mass index(BMI), differentiation degree, and related hematological indexes], specific treatment conditions and PFS, and to analyze the influence of treatment plan and line number on the curative effect. Results : The PFS of chemotherapy plus immunotherapy was significantly better than that of chemotherapy alone(P<0.05), and the median PFS of the two was 7.17 months(95%CI5.85-8.49) and 5.33 months(95%CI3.96-5.70), respectively. In the combination group, the overall ORR was 27.5% and DCR was 94.8%. In the chemotherapy group alone, the overall ORR was 9.7% and DCR was 69.4%.In the chemotherapy plus anti-PD-1 group, a high prognostic nutritional index(PNI) level also provided superior PFS in patients with a 47% reduction in the risk of progression versus a low PNI level [HR0.53(95%CI0.30-0.96);P<0.05]. The median PFS was 7.47 months(95%CI5.83-9.11) with a high PNI level versus 6.00 months(95%CI4.45-7.55) with a low PNI level. The overall incidence of adverse reactions of chemotherapy combined with anti-PD-1 was slightly higher than that of chemotherapy alone, and the incidence of adverse reactions of grade 3-4 was similar, within a controllable range, and could be improved after clinical treatment. Conclusion The efficacy of anti-PD-1 combined with chemotherapy in patients with advanced gastric cancer is better than that of chemotherapy, and the adverse reactions are controllable. In the chemotherapy plus anti-PD-1 group, patients with high PNI levels achieved a higher PFS.

Objective To explore the therapeutic mechanism of compound Yuye Decoction against diabetic cardiomyopathy(DCM).Methods Drugbank,Gene Cards,OMIM and PharmGKb databases were used to obtain DCM-related targets,and the core targets were identified and functionally annotated by protein-protein interaction network analysis followed by GO and KEGG enrichment analysis.The"Traditional Chinese Medicine-Key Component-Key Target-Key Pathway"network was constructed using Cytoscape 3.9.1,and molecular docking was carried out for the key components and the core targets.In the animal experiment,Wistar rat models of DCM were treated with normal saline or Yuye Decoction by gavage at low(0.29 g/kg)and high(1.15 g/kg)doses for 8 weeks,and the changes in cardiac electrophysiology and histopathology were evaluated.The changes in serum levels of LDH,CK,and CK-MB were examined,and myocardial expressions of PI3K,P-PI3K,Akt,P-AKT,BAX,IL-6,and TNF-α were detected using Western blotting.Results We identified 61 active compounds in Yuye Decoction with 1057 targets,3682 DCM-related disease targets,and 551 common targets between them.Enrichment of the core targets suggested that apoptosis,inflammation and the PI3K/Akt pathways were the key signaling pathways for DCM treatment.Molecular docking studies showed that the active components in Yuye Decoction including gold amidohydroxyethyl ester and kaempferol had strong binding activities with AKT1 and PIK3R1.In DCM rat models,treatment with Yuye Decoction significantly alleviated myocardial pathologies,reduced serum levels of LDH,CK and CK-MB,lowered myocardial expressions of BAX,IL-6 and TNF-α,and increased the expressions of P-PI3K and P-AKT.Conclusion The therapeutic effect of compound Yuye Decoction against DCM is mediated by its multiple active components that act on multiple targets and pathways to inhibit cardiomyocyte apoptosis and inflammatory response by regulating the PI3K/Akt signaling pathway.

Objective To explore the therapeutic mechanism of compound Yuye Decoction against diabetic cardiomyopathy(DCM).Methods Drugbank,Gene Cards,OMIM and PharmGKb databases were used to obtain DCM-related targets,and the core targets were identified and functionally annotated by protein-protein interaction network analysis followed by GO and KEGG enrichment analysis.The"Traditional Chinese Medicine-Key Component-Key Target-Key Pathway"network was constructed using Cytoscape 3.9.1,and molecular docking was carried out for the key components and the core targets.In the animal experiment,Wistar rat models of DCM were treated with normal saline or Yuye Decoction by gavage at low(0.29 g/kg)and high(1.15 g/kg)doses for 8 weeks,and the changes in cardiac electrophysiology and histopathology were evaluated.The changes in serum levels of LDH,CK,and CK-MB were examined,and myocardial expressions of PI3K,P-PI3K,Akt,P-AKT,BAX,IL-6,and TNF-α were detected using Western blotting.Results We identified 61 active compounds in Yuye Decoction with 1057 targets,3682 DCM-related disease targets,and 551 common targets between them.Enrichment of the core targets suggested that apoptosis,inflammation and the PI3K/Akt pathways were the key signaling pathways for DCM treatment.Molecular docking studies showed that the active components in Yuye Decoction including gold amidohydroxyethyl ester and kaempferol had strong binding activities with AKT1 and PIK3R1.In DCM rat models,treatment with Yuye Decoction significantly alleviated myocardial pathologies,reduced serum levels of LDH,CK and CK-MB,lowered myocardial expressions of BAX,IL-6 and TNF-α,and increased the expressions of P-PI3K and P-AKT.Conclusion The therapeutic effect of compound Yuye Decoction against DCM is mediated by its multiple active components that act on multiple targets and pathways to inhibit cardiomyocyte apoptosis and inflammatory response by regulating the PI3K/Akt signaling pathway.

Objective To establish a clinical-CT model,and to observe its value for evaluating lymphovascular invasion(LVI)and/or perineural invasion(PNI)in esophageal squamous cell carcinoma(ESCC).Methods Data of 156 ESCC patients were retrospectively analyzed.The patients were divided into positive group(n=58,LVI[+]and/or PNI[+])and negative group(n=98,LVI[-]and PNI[-])according to postoperative pathological results.Clinical and CT data were compared between groups.Logistic regression analysis was performed to establish a model,and its efficacy of evaluating ESCC LVI and/or PNI was analyzed.Results Significant differences of carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),tumor thickness,tumor volume and CT venous phase value(CTV),the difference between CTV and CT plain phase value(CTP)(△CTV-P)and venous phase enhancement rate(V％)were found between groups(all P＜0.05),and the area under the curve(AUC)of the above parameters for evaluating ESCC LVI and/or PNI was 0.702,0.690,0.731,0.744,0.621,0.631 and 0.599,respectively.CEA,CA199,tumor thickness,tumor volume and CTV were all independent predictive factors for ESCC LVI and/or PNI.A combined model was established based on the above features,and its accuracy,sensitivity and specificity for evaluating ESCC LVI and/or PNI was 82.05％,65.52％and 91.84％,respectively,with AUC of 0.838,higher than that of each single parameter(all P＜0.05).Conclusion The established clinical-CT model could effectively evaluate ESCC LVI and/or PNI.

Purpose To analyze the correlation between quantitative parameters of spectral CT and the mutation status of epidermal growth factor receptor(EGFR)and anaplastic lymphoma kinase(ALK)genes in solid lung adenocarcinoma,in order to predict the expression of gene mutation in solid lung adenocarcinoma by combining spectral parameters with clinical indicators.Materials and Methods The imaging and clinical data of 86 patients in the First Affiliated Hospital of Xinxiang Medical College pathologically confirmed with lung adenocarcinoma who underwent energy spectral CT plain and enhanced scans from May 2020 to May 2022 were retrospectively collected.According to the mutation status of EGFR and ALK genes,all patietns were divided into mutation group(43 cases)and wild group(43 cases).The single-energy CT values(including 40 keV,70 keV and 100 keV),slope of energy spectrum curve,effective atomic number during plain scan,iodine concentration in arterial and venous phases,water concentration and iodine concentration in arteries at the same level were obtained,and standardized iodine base value was also calculated.Statistically significant parameters were used to construct the prediction model,and the receiver operating characteristic curve was performed to evaluate the prediction efficiency of the model.Results There were statistically significant differences in gender and smoking status between the EGFR mutation group and the wild-type group(χ2=5.628,P=0.018;χ2=4.214,P=0.040).There were statistically significant differences in plain scan effective atomic number and energy spectrum slope,arterial phase 40 keV,70 keV and 100 keV single-energy CT values,40 keV single-energy CT values in the venous phase,the slope of the arteriovenous dual-phase energy spectrum and the standardized iodine base value between the two groups(t=2.067-4.394,all P<0.05).Logistic regression analysis showed that normalized iodine base value and energy spectrum slope in venous phase were the independent predictors of EGFR gene mutation status.There were no significant differences in quantitative parameters of plain scan and arterial phase energy spectrum CT between the ALK mutant group and the wild-type group(P>0.05).There was statistically significant difference in water base value of venous phase between the two groups(t=2.058,P=0.043).Conclusion The quantitative features of spectral CT may be correlated with the mutation status of EGFR and ALK genes in solid lung adenocarcinoma,and the Logistic regression model based on the combination of quantitative features of spectral CT and clinical features has certain value in predicting EGFR gene mutation.

Objective To investigate the status of thriving at work among junior nurses,and to analyze the influencing factors,so as to provide theoretical bases for promoting the job growth of junior nurses and improving the level of thriving at work.Methods From January to March 2023,431 junior nurses from 3 tertiary hospitals in Xinjiang Uygur Autonomous Region were selected as the research subjects.Questionnaire survey were conducted through the General Information Questionnaire,the Thriving at Work Scale,and the Job Crafting Scale.The univariate analysis and multiple linear regression were used to analyze the influencing factors of thriving at work among junior nurses.Results A total of 431 nurses with low seniority completed the survey.The total score of thriving at work is(35.46±6.74)score.Multiple linear regression analysis showed that age,education level and job remodeling score were the factors affecting the job prosperity of junior nurses(P＜0.05).Conclusion The thriving at work of junior nurses was at a moderate level.Nursing managers should strengthen the benign guidance of junior nurses,provide sufficient resource support,improve the level of job remodeling to promote the thriving at work of junior nurses and maintain the stability of organizational development.

Objective To explore the dynamics of carers'caregiving dilemmas during different stages of disease progression in patients with diabetic foot ulcers,and to provide a basis for giving precise intervention strategies.Methods Based on the theory of Timing It Right,the phenomenological study was adopted.A purposive sampling method was used to select carers of patients with diabetic foot ulcers who were hospitalised in the Wound Repair Unit of a tertiary hospital in Beijing from March 2023 to February 2024 to conduct semi-structured interviews,and the data were analysed using the Colaizzi 7-step analysis method.Results Combined with the theory of Timing It Right,5 stages of diabetic foot ulcer development were formed,and 5 themes were extracted(①diagnostic period:mixed emotions,facing the dilemma of being unable to do anything;②therapeutic period:lack of knowledge of the disease,and the difficulties of bedside care;③recovery period:contradictions of the desire for rapid healing and the lack of caregiving ability;④transition period:poor patient adherence,and the hope for professional support;⑤adaptation period:the accumulation of negative emotions,and the persistence of caregiving difficulties),and 12 sub-themes.Conclusion At different stages of disease development in patients with diabetic foot ulcers,the caregiving dilemma of caregivers changes dynamically,and healthcare professionals should provide professional,personalised,and high-quality professional support according to their caregiving experience and needs at different stages to improve their quality of care and promote patients'recovery.

Objective:To systematically evaluate the psychological experience of financial toxicity in breast cancer patients.Methods:A computer search was conducted in Web of Science, PubMed, Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang, and VIP for qualitative studies on the psychological experience of financial toxicity among breast cancer patients up to April 15, 2023. The Joanna Briggs Institute's quality assessment criteria for qualitative research were used for literature quality evaluation, and an aggregative integration method was applied for data analysis.Results:Ten studies were included, from which 56 distinct themes were extracted. These themes were consolidated into 11 new categories, forming three integrated results: multidimensional negative experiences in coping with financial toxicity, needs and expectations in dealing with financial toxicity, and strategies for dealing with financial toxicity.Conclusions:Breast cancer patients face varying degrees of financial toxicity, negatively impacting their physical and mental health. Healthcare professionals should pay close attention to the characteristics and needs of patients coping with financial toxicity. Continuous assessment of their financial status and implementation of comprehensive intervention strategies and measures through multiple channels and approaches are needed to help reduce the issues of financial toxicity.

Group A Streptococci(GAS)can cause multiple diseases such as pharyngotonsillitis, scarlet fever, streptococcal toxic shock syndrome(STSS), necrotizing fasciitis, and so on, making it extremely difficult to monitor all GAS infections.Developed countries such as the United States and the United Kingdom have classified invasive GAS diseases/infections(iGAS) or certain specific types, such as STSS, as notifiable diseases.China only includes scarlet fever caused by GAS infections in the legal infectious diseases.Although case reports or clinical studies of STSS and necrotizing fasciitis in China can be found, there is a lack of investigation and summary on iGAS, and there are few materials to introduce its definition and diagnostic criteria.Based on a recently diagnosed typical case, this paper intends to introduce the definition and diagnostic criteria of iGAS adopted in the United States, the United Kingdom and other developed countries, as well as the valuable early manifestations and risk factors, and the incidence of iGAS.Given the epidemiological changes in GAS infections in recent years, this paper also emphasizes the importance of paying attention to GAS infections, especially iGAS, aiming to arouse the attention of China′s clinical doctors and urge them to carry out research on this group of diseases.