Objective To investigate the efficacy and safety of camrelizumab monoclonal antibody combined with molecular-targeted therapy in elderly patients with unresectable or advanced hepatocellular carcinoma(HCC).Methods A retrospective analysis was performed for the patients with unresectable/advanced HCC who attended six hospitals from January 1,2019 to March 31,2021,and all patients received camrelizumab monoclonal antibody treatment,among whom 84.8%also received targeted therapy.According to the age of the patients,they were divided into elderly group(≥65 years)and non-elderly group(＜65 years).The two groups were assessed in terms of overall survival(OS),progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),and immune-related adverse events(irAE).The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups;the independent samples t-test was used for comparison of normally distributed continuous data,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The Kaplan-Meier method was used for survival analysis,and the log-rank test was used for comparison of survival curves.Univariate and multivariate Cox proportional hazards regression analyses were used to determine the independent influencing factors for PFS and DCR at 6 months.Results A total of 99 HCC patients were enrolled,with 27 in the elderly group and 72 in the non-elderly group.The elderly group had an OS rate of 67.8%,an ORR of 44.4%,and a DCR of 74.1%at 12 months and a median PFS of 6.4(95%confidence interval[CI]:3.0-12.4)months,with no significant differences compared with the non-elderly group(all P＞0.05).The median OS was unavailable for the elderly group,while the non-elderly group had an OS of 18.9(95%CI:13.0-24.8)months;there was no significant difference between the two groups(P=0.485).The univariate and multivariate Cox regression analyses showed that major vascular invasion(MVI)was an independent risk factor for PFS(hazard ratio[HR]=2.603,95%CI:1.136-5.964,P=0.024)and DCR(HR=3.963,95%CI:1.671-9.397,P=0.002)at 6 months,while age,sex,etiology of HBV infection,presence of extrahepatic metastasis,Child-Pugh class B,and alpha-fetoprotein＞400 ng/mL were not associated with PFS or DCR at 6 months.For the elderly group,the incidence rates of any irAE and grade 3/4 irAE were 51.9%and 25.9%,respectively,with no significant differences compared with the non-elderly group(P＞0.05),and skin disease was the most common irAE in both groups(39.4%).Conclusion Camrelizumab monoclonal antibody combined with molecular-targeted therapy has similar efficacy and safety in patients with unresectable/advanced HCC aged≥65 years and those aged＜65 years.MVI is associated with suboptimal response to immunotherapy and poor prognosis.

Objective:To design an improved lamina hook system and compare its biomechanical properties with traditional lamina hook system in fixation of lumbar spondylolysis.Methods:The thin layer CT data of the lumbosacral vertebrae of 20 healthy young male servicemen who underwent physical examination in the outpatient department of the 940th Hospital of Joint Logistics Support Force of PLA from January 2021 to August 2022 were collected. The age of the subjects was 20-30 years [(25.0±3.0)years]. A 3-dimensional model of the L 5 vertebral body was constructed using the 3-dimensional modeling software. The new improved lamina hook was designed according to the measurements including the thickness of the middle area, the longest longitudinal diameter, the curvature radius of the lower edge, the angle between the upper and lower tail ends, the thickness of the lower edge, and the longest diameter of the lower edge of the bilateral L 5 vertebral plates. One serviceman was selected from the aforementioned group to construct a linear finite element model of segments L 4-S using the 3-dimensional virtual software (normal model, model A), based on which, the L 5 bilateral spondylolysis model (model B), improved lamina hook model (model C) and traditional lamina hook models (model D) were designed. By constraining both sides of the sacrum and applying a longitudinal load of 400 N on the L 4 vertebral body, the upper 1/3 gravity of the body was simulated, and with a bending moment of 10 N·m along the X, Y, and Z directions, motions of forward flexion, backward extension, lateral bending, rotation, etc were simulated. The range of motion of segment L 4/5 and L 5/S 1 of model A was evaluated and compared with the findings of the previous researches to verify its effectiveness. The overall range of motion of models A, B, C, and D, the range of motion of segment L 4/5 and L 5/S 1, the maximum overall displacement, the maximum displacement and stress of the isthmus, the stress distribution and maximum stress of internal fixation of models C and D, and the stress distribution and maximum stress of the vertebral body of models C and D were compared. Results:(1) During forward flexion, backward extension, lateral bending and rotation, the range of motion of model A was 5.01°, 4.03°, 3.91° and 1.42° in segment L 4/5, and was 4.62°, 2.51°, 2.40° and 1.23° in segment L 5/S 1. (2) The overall range of motion, range of motion of segment L 4/5 and L 5/S 1 and maximum overall displacement of models A, C, and D were similar in axial compression, forward flexion, backward extension, left bending, and left rotation, while those of model B were significantly increased. (3) There was no significant difference in the maximum displacement of the isthmus of models A, C, and D under different motion modes, while the maximum displacement of model B in the isthmus was significantly larger than that of models A, C, and D, especially during rotation, increased by 295%, 277%, and 276% respectively. The maximum stress of the isthmus of model C was 0.938 MPa, 1.698 MPa, 0.410 MPa, 2.775 MPa, and 1.554 MPa respectively. The maximum stress in the isthmus of model D was 0.590 MPa, 1.297 MPa, 0.520 MPa, 3.088 MPa, and 2.072 MPa respectively. The maximum stress of the isthmus of models C and D was similar during axial compression and forward flexion, while the stress of the isthmus of model C was smaller than that of model D during backward extension, lateral bending, and rotation, decreased by 21.1%, 10.2%, and 25.0% respectively compared with model D. (4) The maximum stress of internal fixation in models C and D during forward flexion, backward extension, left bending, and left rotation was 135.220 MPa, 130.180 MPa, 200.940 MPa and 306.340 MPa respectively, and was 131.840 MPa, 112.280 MPa, 349.980 MPa and 370.140 MPa respectively. The maximum stress of internal fixation in the two models of internal fixation during forward flexion and backward extension was similar, while it was decreased by 42.6% and 17.2% in model C during left bending and left rotation, compared with model D. (5) The maximum stress of the vertebral body during forward flexion, backward extension, left bending, and left rotation was 79.787 MPa, 36.857 MPa, 37.943 MPa and 96.965 MPa respectively in model C, but was 80.104 MPa, 64.236 MPa, 196.010 MPa and 193.020 MPa respectively in model D. The maximum stress of models C and D was all distributed in the contact area with the internal fixation, and especially during backward extension, left bending, and left rotation, when it was reduced by 42.6%, 80.6%, and 49.8% of model C respectively, compared with that of model D. Conclusions:The improved laminar hook is more consistent with the Chinese anatomized structure of the lamina. Compared with the traditional lamina hook system, the improved lamina hook system can effectively reduce the displacement in all directions and range of motion of lumbar spondylolysis, therefor can significantly reduce the stress of internal fixation and vertebral body and has better biomechanical performance.

Particle size and surface properties are crucial for lymphatic drainage (LN), dendritic cell (DC) uptake, DC maturation, and antigen cross-presentation induced by nanovaccine injection, which lead to an effective cell-mediated immune response. However, the manner in which the particle size and surface properties of vaccine carriers such as mesoporous silica nanoparticles (MSNs) affect this immune response is unknown. We prepared 50, 100, and 200 nm of MSNs that adsorbed ovalbumin antigen (OVA) while modifying β-glucan to enhance immunogenicity. The results revealed that these MSNs with different particle sizes were just as efficient in vitro, and MSNs with β-glucan modification demonstrated higher efficacy. However, the in vivo results indicated that MSNs with smaller particle sizes have stronger lymphatic targeting efficiency and a greater ability to promote the maturation of DCs. The results also indicate that β-glucan-modified MSN, with a particle size of ∼100 nm, has a great potential as a vaccine delivery vehicle and immune adjuvant and offers a novel approach for the delivery of multiple therapeutic agents that target other lymph-mediated diseases.

Abstract: Objective　To understand the epidemiological characteristics of the migratory bird population with hypertension in Hainan and to provide a basis for the health management of the migratory bird population. Methods　One hundred and eighty migratory birds with hypertension who had lived in in the Mangrove Bay community of Chengmai, Hainan for 3 months or more were selected as the study population. Demographic data, including gender, age, ethnicity, occupation, medication use, family history of hypertension, hometown living environment, Hainan living environment (presence of water area and greenbelt around the residence, type of water area and greenbelt), smoking and alcohol consumption, and height and weight were collected by questionnaire and physical examination to investigate the epidemiological characteristics of the study subjects, and unconditional dichotomous logistic regression analysis was used to identify factors affecting the reduction of blood pressure among the hypertensive migratory bird population before and after taking medication in Hainan. Results　A total of 180 study subjects were included, including 77 (42.8%) males and 103 (57.2%) females, with 78 (43.3%) subjects aged ≤65. The hypertension levels were: 87 (48.3%) had normal high blood pressure, 56 (31.1%) had grade 1 hypertension and 37 (20.6%) had grade 2 hypertension. The higher the blood pressure classification, the lower the percentage of migratory individuals whose blood pressure dropped during their stay in Hainan. Age, hypertension classification, dietary habits, living environment, body mass index (BMI), and alcohol consumption were associated with a decrease in blood pressure during Hainan among the study participants who took hypertension medication regularly. Salty diet (OR=2.778, 95%CI:1.070-7.213, P=0.036) and alcohol consumption (OR=2.686, 95%CI:1.042-6.925, P=0.041) were unfavorable factors for lower diastolic blood pressure before taking medication; overweight (OR=3.487, 95%CI:1.306-9.310, P=0.013) was an unfavorable factor in the reduction of diastolic blood pressure after taking medication. Conclusion　The blood pressure reduction is more significant in migratory individuals in migratory individuals under 65 years old, with a light diet, no alcohol consumption and normal BMI. Environmental factors, age, dietary habits and lifestyle are the main causes of blood pressure, which can provide a reference basis for the health management of the migratory birds with hypertension in Hainan.

Objective:To investigate the current situation and influencing factors of humanistic care needs of family members of pregnant women in maternal intensive care unit, and to explore the relationship between humanistic care needs of family members of pregnant women in maternal intensive care unit, relocation stress level and perceived social support ability, so as to provide a basis for clinical nursing staff to implement targeted humanistic care for family members of pregnant women in maternal intensive care unit.Methods:From July to December 2022, 267 family members of pregnant women who were observed in the Maternal Intensive Care Unit of Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital were selected as the research objects by the convenient sampling method. The general information questionnaire, Humanistic Care Needs Scale for Family Members of Pregnant Women in the Obstetric Intensive Care Unit, Family Relocation Stress Scale for Intensive Care Unit Patients and Perceived Social Support Scale were used to carry out a cross sectional investigation.Results:The scores of humanistic care needs, relocation stress scale and perceived social support scale were (175.32 ± 16.04), (35.12 ± 8.11), (57.30 ± 15.43) points, respectively. The length of maternal intensive care unit stay ( B=1.301, P<0.05), the family′s role changed for the first time ( B=2.328, P<0.05), the delivery mode doesn′t match the family′s expectations ( B=-2.407, P<0.05), maternal admission to maternal intensive care unit due to childbirth complications ( B=3.228, P<0.05), relocation stress level of intensive care unit patients′ family members ( B=0.891, P<0.05), and family members′ perceived social support ability ( B=0.461, P<0.05) were the influencing factors of humanistic care needs of maternal family members in maternal intensive care unit factors, which explained 83.2% of the total variation. Conclusions:The humanistic care needs of family members of pregnant women in maternal intensive care unit are at a high level. Medical staff should pay more attention to the family members of pregnant women who stay in maternal intensive care unit for a long time, undergo role change for the first time, have unexpected delivery mode and stay in maternal intensive care unit due to childbirth complications, so as to provide them with more comprehensive humanistic care and establish multiple support system, in order to improve the level of humanistic care for the family members of maternal intensive care unit.

Objective To explore the diagnostic value ofcerebrospinal fluid (CSF) lactic acid (LA) level in bacterial meningitis after craniotomy for cerebral hemorrhage in adults.Methods The clinical data of 162 patients with cerebral hemorrhage,admitted to and accepted craniotomy in our hospital from April 2013 to April 2018,were retrospectively collected;patients were divided into infected group (n=75) and non-infected group (n=87) according to whether postoperative bacterial meningitis occurred;univariate analysis was used to compare the differences of CSF-LA concentration and other indicators of CSF between patients of the two groups;multivariate Logistic regression analysis was used to screen the independent factors affecting the occurrence of postoperative bacterial meningitis;receiver operating characteristic (ROC) curve was used to analyze the predictive values of CSF-LA and other indicators in postoperative bacterial meningitis.Furthermore,17 patients with positive bacterial CSF were divided into Gram-positive (G+) bacteria group (n=9) and Gram-negative (G-) bacteria group (n=8);the predictive values of CSF-LA and other indicators for postoperative meningitis of G-bacteria patients were analyzed in the same way.Results (1) The CSF-LA concentration in infected group ([6.3±2.8] mmol/L) was significantly increased as compared with that in non-infected group ([3.3±1.6] mmol/L,P＜0.05);the results of multivariate Logistic regression analysis showed that CSF-LA was an independent influencing factor for postoperative bacterial meningitis (odd ratio=l.547,95％ confidence interval:1.029-2.326,P=0.036);ROC curve results revealed that the area under the curve of CSF-LA concentration in the diagnosis of bacterial meningitis after craniotomy was 0.854 (95％ confidence interval:0.790-0.904),and the optimal cut-off value was 4.61 mmol/L,with sensitivity of 69.3％,specificity of 92.0％,positive predictive value of 88.1％ and negative predictive value of 77.7％.(2) The CSF-LA concentration in G-bacteria group ([9.9±2.9] mmol/L) was significantly increased as compared with that in G+ bacteria group ([5.2±3.1] mmoi/L,P＜ 0.05);ROC curve results revealed that,in patients with positive bacterial CSF,the area under the curve of CSF-LA concentration in diagnosis of meningitis with G-bacteria after craniotomy was 0.861 (95％ confidence interval:0.610-0.978),and the optimal cut-off value was 7.20 mmol/L with sensitivity of 87.5％,specificity of 88.9％,positive predictive value of 87.5％,and negative predictive value of 88.9％.Conclusion Detection for concentration of CSF-LA can help predicting bacterial meningitis afier craniotomy for cerebral hemorrhage and identify G+ and G-bacteria meningitis.

Objective To compare the dosimetric effects of micro-multileaf collimator (MLC)(2 mm leaf width) and conventional MLC (10 mm leaf width) on inverse intensity-modulated radiotherapy(IMRT) in intracranial stereotactic radiosurgery(SRS). Methods In view of the fact that the micro-MLC has a small open field,30 patients with intracranial tumor with a<10 cm diameter were enrolled in this study. Their inverse dynamic IMRT plans were established using conventional MLC (conventional group) and micro-MLC (micro group) with the same other conditions. The radiation doses to the target volume and the organs at risk (OAR) were compared between the two groups with t test. Results Compared with the conventional group, the micro group had a significantly better dose distribution in the target volume (P=0.019). However, there were no significant differences in D98,D95,D50,and D3between the two groups (P=0.774,0.650,0.170,0.080). The micro group had a 58.7% lower mean homogeneity index and a 20.1% higher mean conformity index than the conventional group (P=0.000). The micro group had significantly lower radiation doses to OAR than the conventional group (P=0.044). The mean Dmeanand Dmaxof the brain stem in the micro group were 10.0% and 8.2%,respectively,lower than those in the conventional group (P=0.768,0.753). The mean Dmeanand Dmax of the right eye and left eye in the micro group were 16.5%,19.3%,21.4%,and 13.4%,respectively,lower than those in the conventional group (P=0.572,0.775 and 0.734,0.630). The mean Dmaxof the left lens, right lens, left optic nerve, right optic nerve, and optic chiasm in the micro group were 50.4%, 24.1%, 38.5%, 27.8%, and 5.7%, respectively, lower than those in the conventional group (P=0.172,0.467, 0.521,0.740,0.899). The PRV100,PRV50,and PRV25of the normal tissue in the micro group were no more than those in the conventional group(P=0.839,0.832,0.972). Conclusions In inverse IMRT in intracranial SRS,micro-MLC is better than conventional MLC because it can improve CI of the target volume and reduce the radiation doses to OAR.

Objective: To analyze the effect and adverse reactions of radiotherapy in patients with primary orbital lymphoma. Methods: A total of 28 patients with primary orbital lymphoma from Tianjin Union Medical Center, the First Central Hospital of Tianjin and Tianjin Dagang Oil Company Hospital between March 2006 and August 2012 were retrospectively analyzed. All the patients received orbital tumor dissection or biopsy, then received radiation therapy. Three patients received chemotherapy with CHOP protocol before radiotherapy. Radiotherapy was delivered routinely with 3D-conformal radiation therapy (CRT) technique with daily 2-2.5 Gy for 5 times per week and 3-5 fields. Total dosage was 20-50 Gy. There were 18 cases of 30 Gy, 1 case of 22 Gy, 1 case of 25 Gy, 1 case of 20 Gy, 1 case of 28.8 Gy, 3 cases of 40 Gy, 1 case of 42 Gy, 1 case of 46 Gy and 1 case of 50 Gy. Results: All the patients had complete remission (CR) after radiotherapy during follow-up. One patient recurred after radiotherapy of 4 months and received CR with radiotherapy again. One patient died of lung infiltration. Acute complications during radiotherapy were conjunctivitis (28 cases, 100.0%) and keratitis (1 case, 3.6%), long-term complications with ophthalmoxerosis (10 cases, 35.7%) and decreased visual acuity (1 case, 3.6%). Conclusion Radiotherapy is an effective method for primary orbital lymphoma, and the adverse reactions can be tolerated for most patients.

Objective To explore the applicability of the Perceived Stress Scale(PSS) in Chinese medical students.Methods 773 medical students completed the PSS and the Depression Anxiety Stress Scale (DASS).The reliability and validity of the PSS were analyzed.Results The exploratory factor analysis showed that two factors were extracted from the scale,which could explain 53.74％ of the total variance.The confirmatory factor analysis verified that the structure of the PSS was two-dimensional (x2/df =2.863,CFI =0.943,TLI =0.924,GFI =0.951,AGFI =0.921,RMSEA =0.07).The internal consistency coefficient of the PSS,the perceived stress subscale and the perceived coping ability subscale were 0.858,0.852 and 0.750.The relationship between the PSS and the DASS was significant,which demonstrated that the PSS had a good criterion-related validity.In addition,t-test showed that girls had a higher level of the perceived stress than boys (t =-2.574,P =0.01),and students who lived in rural had a higher level of the perceived stress than students who lived in urban (t =2.788,P =0.005).Conclusion The study indicates that the PSS has a high level of the reliability and validity,and it is worthy of exploring the perceived stress in medical students.

Objective To evaluate left intra-ventricular diastolic blood flow patterns and fluid dynamics in pre diabetics using vector flow mapping(VFM),and to explore the value of left intra-ventricular hydromechanics characteristics assessment of intracardiac flow by VFM with more sensitive indexes.Methods Forty four patients with type 2 diabetes,twenty-eight pre-diabetes patients and thirty-three normal volunteers underwent VFM to determine the left ventricular(LV) diastolic blood flow patterns and fluid dynamics.The two-dimensional color Doppler flow images data were acquired in standerd apical fourchamber view during 3 complete cardiac cycles.These images were analyzed using a dedicated off-line workstation.At different level (mitral annulus,papillary muscl and apex level),the diastole blood flow parameters of LV including flow velocity and volume,velocity gradients (△V),pressure gradients (△P),diastole flow volume,vortex intensity ( Ⅵ),vortex area ( VA),vortex radius (VA) were derived.Thedifferences of the above parameters were compared among the three groups.The correlationship between diastolic function parameters and LV hydromechanics indexes were analyzed.Results ① Compared to normal group and pre-diabetics group,the LV diastolic function parameters E/A and e/a in diabetics group were lower( P ＜0.01),with no differences for E/e( P ＞0.05).There were no significant diffrences of these indices between diabetics group and pre-diabetics group( P ＞0.05).②)Compared to normal group,the intraventricular peak flow velocity at basal level,△V and △P in diabetics group and pre-diabetics group were lower( P ＜0.01),but there were no significant differences of these indices between diabetics group and prediabetics group( P ＞ 0.05).③Compared to normal group,the diastolic positive volume at basal level in diabetics group and pre-diabetics group was lower ( P ＜0.01 ),but there was no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).④ Compared to the normal group,the Ⅵ in diabetics and pre-diabetics group was decreased,but there were no significant differences ofthese indices between diabetics group and pre-diabetics group( P ＞0.05).The VA and VR in diabetics and pre-diabetics group were increased,but there were no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).⑤ There were no correlationship between diastolic function parameters and LV hydromechanics indexes.Conclusions There is the same LV diastolic blood flow patterns and fluid dynamics existed in pre-diabetics as diabetics.VFM could be used as a new methods to demonstrate the early left intra-ventricular fluid dynamics damages in pre-diabetics patients.