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

Gastric cancer is among the most common malignant tumors worldwide.Due to its subtle early symptoms and suboptimal screening rates,a significant proportion of patients are diagnosed with advanced-stage gastric cancer,which adversely influences patient prognosis.In recent years,with the advancement of research,immunotherapy for gastric cancer has made significant strides,demonstrating particularly remarkable efficacy in cases of unresectable and metastatic gastric cancer.This has established it as an effective treatment method following surgery,chemotherapy,radiotherapy,and targeted therapy.Immunotherapy involves artificially modulating the immune system using strategies such as adoptive cell therapy,immune checkpoint inhibitors,and tumor vaccines.Although immunotherapy has broad prospects,it faces many challenges and problems in clinical application.This review delineates the clinical application of immunother-apy in gastric cancer and discusses the extant challenges therein.

Objective:To investigate the effect of failure mode and effect analysis (FMEA) based catheter information platform in preventing catheter-related bloodstream infection (CRBSI) in intensive care unit to improve the current status of CRBSI.Methods:In this study, a retrospective cohort study was conducted using the purposive sampling method, and 140 patients with indwelling central venous catheters admitted to the ICU of Peking University Shenzhen Hospital from August to December 2021 were set as the control group; the 140 patients with indwelling central venous catheters admitted to the ICU from January to May 2022 were set as the observation group. The control group used electronic forms to record and manage at the bedside after CRBSI cluster nursing measures were given, and the observation group used the catheter information platform based on FMEA to conduct information management on catheter evaluation and maintenance process after CRBSI cluster nursing measures were given. Compared the implementation rate (6 items), implementation time, qualification rate, and incidence of CRBSI in ICU patients between two groups of ICU nurses.Results:The implementation rate of CRBSI cluster nursing measures among ICU nurses in the observation group: strict hand hygiene by nurses was 87%(122/140), maximum aseptic barrier during puncture was 97%(136/140), aseptic operation during catheter maintenance was 91%(128/140), 75% alcohol disinfection of connectors was 84%(118/140), 24-hour change of infusion lines was 95%(133/140), and timely change of patches/dressings was 89%(125/140), they were greater than those in the control group 70%(98/140), 87%(122/140), 71%(100/140), 61%(86/140), 71%(99/140), 69%(96/140), the differences were statistically significant ( χ2 values were 9.67 to 29.07, all P<0.05); the execution time and qualification rate among ICU nurses in the observation group were (9.11 ± 2.83) minutes and 91.4% (128/140), the control group were (10.00 ± 2.84) minutes and 60.7% (85/140), with statistically significant differences ( t value was -2.64, χ2 values was 36.28, all P<0.05). Conclusions:The FMEA-based catheterization information platform can help enhance the efficiency of the implementation of CRBSI clustering nursing measures by ICU nurses, improve the quality of care, and thus reduce the occurrence of CRBSI, and the feasibility of clinical promotion is high.

Objective To investigate the effect of MDM2 inhibitor RG-7388 on the proliferation, cell cycle, and apoptosis of diffuse large B-lymphoma (DLBCL) cells. Methods DLBCL cell strains SUDHL2 and HBL1 were treated with 2, 4, and 8 μmol/LRG7388, respectively. Cell proliferation was detected by CCK8 and EdU methods. Apoptosis was measured by Annexin V–FITC/PI double staining and Caspase 3/7-Glo enzyme activity methods. Cell cycle was assessed by flow cytometry. Changes in the expression of cell cycle and apoptosis-related proteins were determined by Western blot. Results The IC₅₀ of RG7388 for inhibiting SUDHL2 and HBL1 cells were 3.36 and 3.76 μmol/L, respectively, and the inhibitory effect of RG7388 was dose dependent. The proportions of G₁ phase and apoptotic cells in the SUDHL2 and HBL1 cells treated with different doses of RG7388 were significantly higher than those in the control group (all P<0.05). The activity of Caspase 3/7 increased gradually with RG7388 concentration, compared with that in the control group. The expression levels of p53, p27, p21, and PARP increased, whereas the expression of Mcl-1 and Bcl-x_L was down-regulated (all P<0.05). Conclusion MDM2 inhibitor RG-7388 inhibits the proliferation of DLBCL cells, triggers cell cycle arrest in the G₁ phase, and induces apoptosis through the p53 pathway.

Objective:To investigate and analyze the current situation and influencing factors of professional decision-making self-efficacy of male nurses.Methods:Convenience sampling was used to select 133 male nurses from September to October 2020 in Shenzhen City as the research objects. The Self-efficacy Scale for Career Decision-making was used to conduct self-evaluation, career information collection, career goal selection, career planning formulation, and job-selection problem resolution.Results:Attitudes towards nursing majors, academic qualifications, reasons for applying for nursing majors, monthly family income, whether it is an only child, family residence, work status, number of job changes, mother′s education level, and married or not were the factors that affect male nurses′ professional self-efficacy ( t values were -1.989-12.523, F values were 7.476-325.316, P<0.05 or 0.01). Conclusion:Career decision-making self-efficacy has a good guiding role in the career selection, development and planning of male nurses. Medical units should formulate reasonable training methods or related training for new male nurses entering the clinic, so as to increase male nurses′ recognition of their occupations, thereby enhancing them Career decision-making self-efficacy.

Objective:To construct a set of hospital intelligent nursing evaluation index system based on the Delphi method.Methods:Through literature analysis and expert interviews, the draft of hospital intelligent nursing evaluation index system was prepared. A total of 30 experts who worked in health management industry, clinical nursing industry, information industry, intelligent industry, science and technology industry and policy research for more than 10 years were selected to conduct two rounds of expert letter consultation from January to October 2018 to establish the evaluation index system.Results:The recovery rates of the two rounds of questionnaires were 90.0% (27/30) and 92.6% (25/27) , the expert authority coefficients were 0.815 and 0.878, and the expert coordination coefficients were 0.266 and 0.415, respectively. The significance scores of two rounds of indicators were both greater than 0.3 points, and the coefficients of variation were both less than 0.3. After two rounds of consultation, experts' opinions tended to be consistent, and finally an intelligent nursing hospital evaluation index system consisting of 3 first-level indicators, 16 second-level indicators and 69 third-level indicators was established.Conclusions:The evaluation indexes of intelligent nursing hospital based on the effective expert interview method is scientific, which can provide reference and guidance for standardizing the construction of intelligent nursing evaluation in hospitals.

Cuffless technique holds great promise to measure blood pressure (BP) in an unobtrusive way, improving diagnostics and monitoring of hypertension and its related cardiovascular diseases, and maximizing the independence and participation of individual. Pulse transit time (PTT) has been the most commonly employed techniques for cuffl ess BP estimation. Many studies have been conducted to explore its feasibility and validate its performance in the clinical settings. However, there is still issues and challenges ahead before its wide application. This review will investigate the understanding and development of the PTT technique in depth, with a focus on the physiological regulation of arterial BP, the relationship between PTT and BP, and the summaries of the PTT-based models for BP estimation.
Blood Pressure ; Cardiovascular Diseases ; Hypertension ; Pulse Wave Analysis

OBJECTIVE： To establish a method for simultaneous determination of 6 components in Chaihuang tablets， such as baicalin， wogonoside， baicalein， wogonin， saikosaponin a and saikosaponin d in Chaihuang tablets. METHODS： HPLC-DAD method was used to detect 3 batches of Chaihuang tablets from same manufacturers. The determination was performed on Agilent Eclipse XDB-C18 column with mobile phase consisted of acetonitrile-triethylamine phosphate aqueous solution （pH adjusted to 7.0， gradient elution） at flow rate of 1.0 mL/min. The detection wavelengths were set at 210 nm （saikosaponin a， saikosaponin d） and 277 nm （baicalin， wogonoside， baicalein， wogonin）. The column temperature was 30 ℃， and sample size was 5 μL. RESULTS： The linear ranges of baicalin， wogonoside， baicalein， wogonin， saikosaponin a and saikosaponin d were 0.379 5-7.590 4 μg，   0.082 96-1.659 2 μg， 0.039 39-0.787 8 μg， 0.040 72-0.814 4 μg， 0.040 45-0.809 0 μg， 0.038 63-0.772 6 μg （all r≥0.999 3）， respectively. The limits of detection were 0.008， 0.007， 0.005， 0.005， 0.020 and 0.018 μg/mL. The limits of quantitation were 0.025， 0.022， 0.015， 0.015， 0.060， 0.054 μg/mL. RSDs of precision， reproducibility and stability tests （48 h） were all lower than 1.5％ （n＝6）. Average recoveries were 98.46％， 97.06％， 100.90％， 96.13％， 96.91％， 96.57％ （RSD＜2.0％， n＝6）. CONCLUSIONS： Established method is simple， accurate and reproducible for 6 components in Chaihuang tablets， and can be used for quality control of the tablet.

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 explore the willingness ofhemodialysis nurses and current application of indwelling needles for dialysis. Methods Based on the method of random survey and SPSS 22.0 statistical software, 295 hemodialysis nurses from 34 hospitals in Shenzhen were investigated by aself-designed questionnaire in a way to explore and application of indwelling needles for dialysis and the nurses' willingness of using them. Results Among 248 collected valid questionnaires, there were 200 (80.6%) hemodialysis nurses who are willing to use dialysis indwells. Univariate analysis showed the results are influenced by the class of hospitals and the safety of indwelling needles in their mind (P＜ 0.05). Multivariate analysis showed that whether nurses know dialysis indwelling needle and the safety of the dialysis indwelling needles in their mind are the influencing factors of their willingness to use the indwelling needle for dialysis. There were 167 (67.34%) nurses who had never used the dialysis indwelling needle. The first two influence factor of promotion of dialysis indwelling needle were the entrenched operating habits (31.05%) and their department had not applied the usage of them (27.82%).The biggest concern of hemodialysis nurses was the fixation of the indwelling needle (16.13%), followed by the punch/seal problem (8.87%). Conclusions The vast majority of hemodialysis nurses were willing to use dialysis indwelling needle in nursing work, but its promotion and application was not optimistic. Therefore, intervention measures should be carried out at individual, department and hospitallevel, intensifying the training and conceptual changes of department regulators and nurses.