BACKGROUND: The combination of immune checkpoint inhibitors and chemotherapy (ICI + Chemo) shows promise in treatment of recurrent or metastatic nasopharyngeal carcinoma (RM-NPC), but some patients received limited benefit and the prognostic factors of the treatments remain unclear. Furthermore, ICIs efficacy in subsequent treatments needs further evaluation. METHODS: A systematic search on PubMed, Embase, the Cochrane Library, and major conference proceedings was conducted to identify relevant studies for meta-analysis. The study was designed to compare ICI + Chemo with chemotherapy in first-line treatment and identify efficacy predictors, and to evaluate ICIs alone in subsequent-line treatment for RM-NPC, with a focus on progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (AEs). RESULTS: Fifteen trials involving 1928 patients were included. Three trials compared ICI + Chemo with chemotherapy as a first-line treatment, while 12 trials evaluated ICIs alone in subsequent-line treatment of RM-NPC patients. First-line ICI + Chemo showed superior PFS (hazard ratio [HR] = 0.52, 95% confidence interval [CI], 0.43-0.63; P <0.001) and ORR (risk ratio [RR] = 1.14, 95% CI, 1.05-1.24; P <0.001) compared to chemotherapy, without increased AEs (RR = 1.01, 95% CI, 0.99-1.03; P = 0.481). Neither programmed death-ligand 1 (PD-L1) nor other factors predicted the efficacy of ICI + Chemo vs . chemotherapy. Subsequent-line ICIs alone had a median PFS of 4.12 months (95% CI, 2.93-5.31 months), an ORR of 24% (95% CI, 20-28%), with grade 1-5/grade 3-5 AEs at 79%/14%. However, ICIs alone were associated with significantly shorter PFS (HR = 1.31, 95% CI, 1.01-1.68; P = 0.040) than chemotherapy alone. CONCLUSIONS ICI + Chemo confers superior survival benefits compared to chemotherapy in first-line RM-NPC treatment, independent of PD-L1 expression or other factors. However, ICIs alone demonstrate a manageable safety profile but do not surpass chemotherapy in efficacy for subsequent-line treatment.
Humans ; Immune Checkpoint Inhibitors/adverse effects* ; Nasopharyngeal Carcinoma/drug therapy* ; Nasopharyngeal Neoplasms/drug therapy* ; Neoplasm Recurrence, Local/drug therapy*

OBJECTIVE: To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. METHODS: A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups ( P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. RESULTS: Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant ( P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group ( P<0.05), the incision was significantly longer ( P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups ( P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups ( P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups ( P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups ( P<0.05). There was no significant difference between the two plate groups ( P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups ( P>0.05). CONCLUSION For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
Humans ; Femoral Neck Fractures/diagnostic imaging* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Bone Screws ; Adult ; Aged ; Treatment Outcome ; Printing, Three-Dimensional ; Operative Time

Objective:To analyze the influencing factors of the public hospital′s WeChat official accountcommunication effect, for references for improving the public hospital′s WeChat official account′s public opinion guidance in health dissemination field.Methods:The communication data of all the tweets on the official account of a tertiary hospital from 2018 to 2021 were obtained, taking the tweets reading times as the evaluation index of the communication effect of the WeChat official account. The number of sharing times, the number of title words, punctuation points, the first launch platform and content type were took as factors that may affect comounication effectiveness for single factor analysis and multiple linear regression analysis.Results:A total of 1 102 tweets were included, with an average reading times of 10 670, and an average sharing times of 411. The top 10 tweets in terms of reading times were mainly about the treatment of major diseases, emergencies, common misconceptions and health popular science. The sharing times and the hand-painted entries were positively correlated with the reading times( P<0.05), while the number of title words and punctuation was negatively correlated with the reading times( P<0.05). The reading times of tweets varied with different title sentence structures, initial platforms, source departments, and content types, and the differenceswere statistically significant( P<0.05). The sharing times, hand-painted entries, title sentence structures and content typeswere the influencing factors of the public hospital′s WeChat official account communication effect( P<0.05). Conclusions:The tweets of a public hospital′s WeChat official account with high reading times focused on the hot issues that people pay attention to, and there were many factors influencing the communication effect. The author suggested that the WeChat official account of public hospitals should focus on the needs of the people, promote the construction of high-quality content, and further strengthen the design level of copywriting to improve its audience and communication power.

Objective To discuss the influence of Qihong Fang (Wolfberry and Hawthorn Decoction) on heart in aged rats with cold-congealing and blood-stasis pattern.Methods SD rats (n =48) were divided randomly into normal control group,model group,vitamin E group (13.5 mg/kg),low-dose Qihong Fang group (45 mg/kg),mid-dose Qihong Fang group (90 mg/kg) and high-dose Qihong Fang group (180 mg/kg).The aged rat model of cold-congealing and blood-stasis pattern was established through 28-d ozone leading to aging and 14-d ice water leading to cold-congealing and blood-stasis pattern in other 5 groups except of control group.On the 29th d,the blood samples were collected from abdominal aorta for isolating serum and plasma,and heart was separated too.The vitalities of serum total superoxide dismutase (T-SOD),Cu-Zn SOD,Mn-SOD,catalase (CAT),glutathione peroxidease (GSH-PX),content of malondialdehyde (MDA),and prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT) and fibrinogen (FIB) were detected.The morphologic changes of heart cells were observed after HE staining,fiber deposition quantity was observed after Masson staining,expression of transforming growth factor β1 (TGF-β1) was detected by using immunohistochemistry technique for reviewing aging model of cold-congealing and blood-stasis pattern,and protective effect of Qihong Fang on heart was observed in rats.Results Compared with normal control group,the vitalities of T-SOD,Cu-Zn-SOD,Mn-SOD,CAT and GSH-PX decreased significantly (P ＜ 0.05),MDA content increased significantly (P＜ 0.05,PT and APTT decreased significantly (P ＜ 0.05),and FIB content increased significantly (P ＜0.05) in model group.After Masson staining,morphometry observation by light microscope showed deposition of heart collagen fibers increased significantly (P ＜ 0.05),and expression of TGF-β1 increased significantly (P ＜ 0.05).Compared with control group,the vitalities of T-SOD,Cu-Zn-SOD,CAT and GSH-PX increased significantly (P ＜ 0.05),MDA content decreased significantly (P ＜ 0.05),PT and ATPP increased significantly (P ＜ 0.05),FIB content decreased significantly (P ＜ 0.05),deposition of heart collagen fibers decreased significantly (P ＜0.05),and expression of TGF-β1 decreased significantly (P ＜ 0.05) in mid-dose and high-dose Qihong Fang groups.Conclusion Qihong Fang has a protective effect on heart in aged rats with cold-congealing and blood-stasis pattern.

Objective To investigate the related risk factors for small artery occlusion (SAO) and its 2 subtypes. Methods The clinical and imaging data in 291 patients with first-ever stroke who met the TOAST criteria of large artery atherosclerotic stroke (LAA) or SAO were collected from the Nanjing Stroke Registry Prog-am from December 2009 to November 2010. All the patients were divided into a LAA group (n = 120) and a SAO group (n = 171). The latter was redivided into either a lacunar infarction with ischemic leukoaraiosis (ILA) subgroup (n = 84)or an isolated lacunar infarction (ILI) subgroup (n = 87). The risk factors of the LAA group and SAO group and its subgroups were compared. Multivariate logistic regression analysis was conducted and the independent risk factors were screened. Results The mean age in the SAO group was larger than that in the LAA group. The proportion of the patients with hypertension and the serum homocysteine (Hcy) level were significantly higher than those in the LAA group (all P ＜0. 05). Multivariate logistic analysis showed that the advanced age (odds ratio, [OR] = 1.041,95% confidence interval [CI] 1.02-1.06, P = 0.045), hypertension (OR = 2. 912,95% CI 1. 11-6. 46, P =0. 031) and increased plasma Hcy (OR = 1. 109, 95% CI 1. 11-1. 32, P =0. 001) were the independent risk factors for SAO. The advanced age (OR = 1. 047,95% CI 1.00-1.09, P = 0.043), hypertension (OR = 2. 632, 95% CI 1.08-6.41, P= 0.033) and increased plasma Hcy (OR = 1. 211, 95% CI 1. 11-1. 32, P ＜0. 001) were the independent risk factors for ILA, while the hypercholesterolemia (OR =0. 136, 95% CI 0. 05-0. 37, P ＜0. 001) was the independent risk factor for ILI. Conclusions The advanced age, hypertension and increased plasma Hcy level may play important roles in the pathogenesis of SAO. The hypercholesterolemia is an independent risk factor for ILI, while advanced age, hypertension and increased plasma Hcy level are the independent risk factors for ILA.

Objective To investigate the relationship between isehemic lesion patterns and Suzuki's vessel grades in adult moyamoya disease(MMD).Methods Forty-four consecutive MMD patients,12 with transient ischemic attack(TIA),30 with cerebral infarct(CI)and 2 with combined TIA and CI,who were diagnosed in Jinling hospital between January of 2004 and July of 2009,were retrieved from Nanjing Stroke Registry Program.Ischemic lesions patterns of CI type of MMD were further divided into two paired subgroups including subcortical subgroup versus cortical subgroup, and subgroup of anterior cerebral circulation versus subgroup of posterior cerebral circulation.In addition,the ipsilateral vessel grades of all symptomatic hemispheres were evaluated by Suzuki's 6-grade system according to the results of cerebral angiography of internal carotid arteries.The percentage of number of hemispheres with ischemic events among the paired groups,including TIA group versus CI group,subcortical subgroup versus cortical subgroup,and subgroup of anterior cerebral circulation versus subgroup of posterior cerebral circulation,were analyzed respectively with changes of the Suzuki's grading.Results For above-mentioned each paired groups.the percentage of number of hemispheres with ischemic events was gradually decreased in the former (namely,11/26,2/13,1/8,0 and 0;15/15,9/11,1/7,0 and 0;15/15,10/11,4/7,0 and 0)and increased in the latter(namely,15/26,11/13,7/8,2/2 and 1/1;0,2/11,6/7,2/2 and 1/1;0,1/11,3/7,2/2 and 1/1 ) from grade 2 to grade 6, and the differences were statistically significant (Z = -2. 33 and P =0. 019,Z = - 4.49 and 0. 00, Z = - 3.66 and 0. 01, respectively ). Moreover, the mean value of Suzuki' s grade was lower in the former than the latter for above-mentioned three groups (2. 29 vs 2. 97, 2. 44 vs 4. 18 and 2. 62 vs 4. 13, respectively). Conclusion The ischemic lesion patterns of adult MMD is changing with the change of Suzuki' s vessel grading. The higher the Suzuki' s grade, the greater the likelihood of ischemic lesions involving the cortical areas of posterior cerebral circulation.

Aspirin can effectively prevent ischemic cerebrovascular disease. However, as the existence of "aspirin resistance" phenomenon, ischemic events still occur in some patients during the aspirin treatment. This article mainly reviews the mechanisms, screening methods and treatment measures of aspirin resistance.