BACKGROUND: Durvalumab after chemoradiotherapy (CRT) failed to bring survival benefits to patients with epidermal growth factor receptor ( EGFR ) mutations in PACIFIC study (evaluating durvalumab in patients with stage III, unresectable NSCLC who did not have disease progression after concurrent chemoradiotherapy). We aimed to explore whether locally advanced inoperable patients with EGFR mutations benefit from tyrosine kinase inhibitors (TKIs) and the optimal treatment regimen. METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases from inception to December 31, 2022 and performed a meta-analysis based on a Bayesian framework, with progression-free survival (PFS) and overall survival (OS) as the primary endpoints. RESULTS: A total of 1156 patients were identified in 16 studies that included 6 treatment measures, including CRT, CRT followed by durvalumab (CRT-Durva), TKI monotherapy, radiotherapy combined with TKI (RT-TKI), CRT combined with TKI (CRT-TKI), and TKI combined with durvalumab (TKI-Durva). The PFS of patients treated with TKI-containing regimens was significantly longer than that of patients treated with TKI-free regimens (hazard ratio [HR] = 0.37, 95% confidence interval [CI], 0.20-0.66). The PFS of TKI monotherapy was significantly longer than that of CRT (HR = 0.66, 95% CI, 0.50-0.87) but shorter than RT-TKI (HR = 1.78, 95% CI, 1.17-2.67). Furthermore, the PFS of RT-TKI or CRT-TKI were both significantly longer than that of CRT or CRT-Durva. RT-TKI ranked first in the Bayesian ranking, with the longest OS (60.8 months, 95% CI = 37.2-84.3 months) and the longest PFS (21.5 months, 95% CI, 15.4-27.5 months) in integrated analysis. CONCLUSIONS: For unresectable stage III EGFR mutant NSCLC, RT and TKI are both essential. Based on the current evidence, RT-TKI brings a superior survival advantage, while CRT-TKI needs further estimation. Large randomized clinical trials are urgently needed to explore the appropriate application sequences of TKI, radiotherapy, and chemotherapy. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022298490.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; ErbB Receptors/genetics* ; Lung Neoplasms/drug therapy* ; Mutation/genetics* ; Protein Kinase Inhibitors/therapeutic use* ; Chemoradiotherapy ; Antibodies, Monoclonal/therapeutic use*

Objective To explore the prevalence of 9 respiratory pathogens from March 2023 to February 2024,as well as the detection efficiency of various methods for pathogens.Methods A retrospective analysis was conducted on the detection of 9 pathogens in 38 948 patients who first presented with respiratory symp-toms from March 2023 to February 2024,as well as the detection efficacy of nucleic acid,antigen,antibody and other methods.Results Firstly,among 38 948 patients,a total of 8 345 cases(21.43%)were detected with at least one pathogen,of which 8 158 cases(20.95%)were detected with only one pathogen,and 187 cases(2.29%,187/8 158)were detected with two or more pathogens.The top three detection rates were SARS-CoV-2(20.37%),mycoplasma pneumoniae(MP,15.58%)and influenza A virus(IVA,10.79%).Secondly,among patients who detected at least one of the nine pathogens,the detection rate was 24.94%in autumn,21.45%in spring,18.54%in summer,and 19.22%in winter,and the difference in detection rates between the four seasons was statistically significant(P<0.001).Thirdly,except for the relatively high detection rates of SARS-CoV-2 in spring(51.24%)and summer(37.31%),and the highest detection rate of IVB in winter(11.28%),the detection rates of other pathogens were highest in autumn.Fourthly,there was a statistically significant difference in the total detection rates among the children group(31.83%),the youth group(12.48%),the middle-aged group(10.70%),and the elderly group(12.43%)(P<0.001).The detection rates of 7 pathogens,including MP,IVA,Influenza B virus(IVB),syncytial virus,CP,adenovirus,and parain-fluenza virus type 1,were highest in children,and there was a statistically significant difference in comparison between different age groups(P<0.05).The detection rate of SARS-CoV-2 in the children group(3.45%)was lower than that in other age groups(30.90%,29.09%,32.16%,P<0.001).There was no statistically significant difference in HPIV-3 between different age groups(P=0.478).Fifthly,there was no significant difference in overall detection rate between male and female(P>0.05).However,the detection rates of MP and CP in female were higher than those in male(P<0.05),while IVA in male was slightly higher than that in female(P=0.014).There were no significant differences in the detection rate of other 6 pathogens between female and male(P>0.05).Sixthly,the detection rate of MP antigen was lower than that of MP nucleic acid detection(P<0.001),and the detection rate of MP antibody detection was lower than that of MP nucleic acid detection(P<0.001).The detection rate of MP antibody detection increased significantly with the extension of time from initial symptoms to medical treatment(P<0.001).Seventhly,the detection rates of antigen of IVA,IVB,RSV and ADV were significantly lower than those of the corresponding nucleic acid(P<0.001),and the detection rates of nucleic acid testing for 4 kinds of pathogen was about 5 times that of the correspond-ing antigen testing(4.75-6.25 times).And the consistency of the detection rate between antigen detection and nucleic acid detection was poor(Kappa=0.046-0.239).Conclusion The prevalence of common respir-atory pathogens from March 2023 to February 2024 exhibits certain characteristics.Moreover,the detection ef-ficiency of different methods for pathogens varies greatly,and appropriate detection methods should be select-ed based on a thorough understanding of their performance.

Objective To explore the acceptability of routine biochemical test results for serum samples with varying degrees of chylous high triglyceride(TG).Methods Blood samples of 69 patients with different degrees of lipids were collected,including 33 patients with mild to moderate lipids(1.7 mmol/L≤TG<5.6 mmol/L)and 36 patients with severe lipids(TG≥5.6 mmol/L).Twenty-nine biochemical tests were detected before and after high-speed centrifugation.The result acceptability before high speed centrifugation of serum was compared with the results after high speed centrifugation as the gold standard[TG and total cholesterol(TC)before centrifugation].The acceptable criteria were subject to the following three conditions at the same time.Firstly,correlation coefficient(R2)was greater than or equal to 0.95.Secondly,the slope of linear re-gression equation was 1.00±0.05.Thirdly,for the same index,the number of samples whose result bias be-fore and after centrifugation was less than 1/2 total allowable error(TEa)in more than 90%of the total sam-ple numbers.Results Firstly,in the mild to moderate lipemia group,22 tests met the criteria,7 tests did not,including total protein(TP),albumin(ALB),TG,aspartate aminotransferase(AST),carbon dioxide(CO2),α-L-fucosidase(AFU),lactate dehydrogenase(LDH)(bias<10%),and the coincidence rate was 75.9%.In the severe lipemia group,12 tests met the criteria,17 tests did not,including pre-albumin(PA),AFU,γ-glu-tamyltransferase(γ-GT),LDH,AST,TC,direct bilirubin(DBIL),CO2,5'-nucleotidase(5'-NT),small and low-density lipoprotein cholesterol(sd-LDL-C),high density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),adenosine deaminase(ADA),cystatin C(CysC),glycosylated albumin(GA),total bilirubin(TBIL)(bias>10%),the coincidence rate was 41.4%,and there was a statistically sig-nificant difference in the coincidence rate between the two groups(P<0.05).Secondly,there was no statisti-cally significant difference in the acceptability of results between continuous monitoring method and endpoint method detection methods(P>0.05).Conclusion Most test results of direct determination with mild or moderate lipemia samples are acceptable,and the bias of unacceptable tests is small(<10%),so it is recom-mended to issue a test report without further sample treatment.However,due to the large number of unacceptable tests and larger bias(>10%),severe lipemia samples should be determined after high-speed centrifugation.

Objective To investigate the changes of 22 bile acid sub components and 17 traditional bio-chemical indicators in serum of patients with non-alcoholic fatty liver disease(NAFLD),and the diagnostic value of detecting the above indicators alone or in combination for NAFLD.Methods A total of 168 NAFLD patients(NAFLD group)and 216 non-NAFLD apparently healthy individuals(non-NAFLD group)were se-lected,bile acid sub components were determined by liquid chromatography tandem mass spectrometry,and traditional biochemical indicators were detected by automatic biochemical analyzer.Results There were sta-tistically significant differences in the levels of 12 bile acid sub components and 12 traditional biochemical indi-cators between NAFLD group and non-NAFLD group(P<0.05).Compared to traditional biochemical indica-tors,bile acid sub components were less affected by body mass index(BMI).The area under the curve for di-agnosing NAFLD by combining three bile acid sub components[taurocholic acid(TCA),sodium taurodeoxy-cholate(TDCA),and tauroursodeoxycholic acid(UDCA)]with three traditional biochemical indicators[ala-nine aminotransferase(ALT),5'Nucleotidase(5'-NT),and small and dense low-density lipoprotein cholester-ol(sd-LDL-C)]was the largest,which was 0.810.Conclusion Twelve kinds of bile acid sub components in the blood of NAFLD patients have changed,and the combined detection of bile acid sub components and tradi-tional biochemical indicators could improve the diagnostic efficacy of NAFLD to a certain extent.

Objective To investigate the effects of acute sleep deprivation on the behavior and synaptic protein expression of rats.Methods Seventy healthy male Wistar rats were randomly divided into seven groups,a Control group and sleep deprivation groups(24,48,72,96,120 and 144 hours).The sleep deprivation rat model was established by the modified multiplatform water environment sleep deprivation method.Spatial learning and memory were assessed by the Morris water maze.Anxiety was assessed by the open field test.The morphology and quantity of hippocampal neurons were observed by Nissl staining.Western blot and Real-time PCR were used to determine the expression of synaptophysin(SYN),post-synaptic density protein-95(PSD-95),and brain-derived neurotrophic factor(BDNF)in rats.Results Compared with the Control group,the numbers of standing and modification were significantly increased by prolongation of the sleep deprivation time(P＜0.05).The escape latency and path length were significantly increased in 120 and 144 h groups(P＜0.05),whereas the number of platform crossings and the percentage of the target quadrant time were significantly decreased(P＜0.01)and negatively correlated to the sleep deprivation time.The expression levels of BDNF,SYN,and PSD-95 were significantly decreased with the prolongation of sleep deprivation time(P＜0.01).Conclusions With the increase in sleep deprivation time,cognitive dysfunction and anxiety gradually deteriorated,which may be related to decreases in the expression of synaptic biomarkers.

Objective To investigate the effect of aqueous extract of Scrophularia ningpoensis(AESN)on AMP-activated protein kinase(AMPK)activity in INS-1 cells under high glucose(HG)conditions.Methods INS-1 cells were cultured in HG medium and treated with different concentrations of AESN.The influences of AESN on cell viability and pyroptotic body formation were detected using the CCK-8 assay.Western blotting was used to observe the effects of AESN on AMPK expression and phosphorylation.The effect of AESN on AMPK activity was measured using time-resolved fluorescence resonance energy transfer(TR-FRET)assay.Results Compared with normal glucose controls,INS-1 cells exposed to HG showed decreased cell viabilities and increased formation of pyroptotic bubbles using CCK-8 assay.Western blotting results indicated that HG exposure led to a decrease in intracellular AMPK phosphorylation levels.However,co-incubation with AESN under HG exposure AESN treatment increased the cell viabilities and phosphorylation of AMPK and decreased the pyroptotic bubbles formation in a concentration-dependent manner.In addition,the results of TR-FRET revealed that AESN treatment effectively increased AMPK activity in a concentration-dependent manner.Conclusion AESN has an activating effect on AMPK activity in HG-treated INS-1 cells.

AIM:To evaluate the efficacy,safety,and economy of camrelizumab(CAM)combined with platinum-containing chemotherapy(CT)for the first-line treatment of locally advanced/meta-static non-small cell lung cancer(NSCLC).METH-ODS:Chinese and English databases such as Pubmed,the Cochrane Library,China Knowledge Network,Wanfang Data,and other related web-sites were systematically searched.After literature screening,quality assessment,and data extraction of the literature according to the inclusion and ex-clusion criteria,two researchers conducted a rapid health technology assessment(HTA).RESULTS:A total of 7 systematic evaluations/Meta-analyses and 17 economics evaluations were included.In terms of effectiveness,compared to docetaxel che-motherapy,CAM+CT significantly prolonged the overall survival(OS),progression-free survival(PFS),and improved the objective remission rate(ORR)of mutation-negative patients with locally ad-vanced/metastatic NSCLC.Compared with CT and pembrolizumab(PEM),CAM+CT significantly pro-longed the PFS,and improved the ORR of mutation-negative patients with locally advanced/metastatic NSCLC.Subgroup analysis showed that CAM+CT significantly prolonged PFS in patients with PD-L1 ≥1％and PD-L1 ≥ 50％compared with CT.Compared with CT,CAM+CT significantly prolonged the OS and PFS of mutation-negative patients with locally advanced/metastatic squamous NSCLC.Compared with sintilimab(SIN),CAM+CT significantly pro-longed the PFS of mutation-negative patients with locally advanced/metastatic squamous NSCLC.Sub-group analysis showed that CAM+CT significantly prolonged OS in patients with PD-L1＜1％com-pared with CT.In terms of safety,CAM+CT was comparable in terms of the occurrence of all grades of adverse events,but the incidence of grade 3 or higher treatment-related adverse events was significantly increased compared with CT and PEM for mutation-negative locally advanced/meta-static NSCLC patients.CAM+CT was significantly in-creased the occurrence of all grades of adverse events compared with CT,but was comparable in terms of the occurrence of grade 3 or higher treat-ment-related adverse events.In terms of economy,CAM+CT has a cost-effectiveness advantage over CT for patients with mutation-negative advanced/metastatic squamous NSCLC.CAM+CT has a cost-effectiveness advantage over CT and PEM+CT;and CAM+CT does not have a cost-effectiveness ad-vantage over SIN+CT for patients with mutation-negative locally advanced/metastatic non-squa-mous NSCLC.CONCLUSION:CAM+CT has good ef-ficacy and cost-effectiveness for the first-line treat-ment of locally advanced/metastatic NSCLC,and the safety aspect is compared with CT,PEM or slightly worse.

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPO) and minimally invasive intramedullary nailing osteosynthesis (MINO) in the treatment of humeral shaft fractures. Methods The clinical data of 53 patients with humeral shaft fractures treated with MIPO and MINO were retrospectively analyzed. The patients were divided into MIPO group of 25 patients and MINO group of 28 patients according to differed surgical approaches. The operation time, blood loss, length of hospital stay, fracture healing time, University of California at Los Angeles (UCLA) shoulder function score at 1 year postoperatively, and Mayo elbow performance score at 1 year postoperatively were compared between the two groups. Results All 53 patients successfully completed the surgery, and no postoperative complications such as surgical site infection, radial nerve injury, fracture nonunion, implant breakage, or loosening occurred. There were no statistically significant differences between the two groups in terms of operation time, blood loss, length of hospital stay, fracture healing time, and Mayo elbow performance score at 1 year postoperatively (P>0.05). The UCLA shoulder function score at 1 year postoperatively was better in the MIPO group than in the MINO group (P < 0.05). One patient in the MIPO group experienced wound fat liquefaction, and one patient in the MINO group experienced radial nerve palsy. Conclusion Both MIPO and MINO can achieve satisfactory results in the treatment of humeral shaft fractures, and both minimally invasive techniques are worthy of clinical promotion. However, MIPO has lesser impact on shoulder function.

This study summarizes the construction background, rules and regulations and institutional settings of the MOOC and Micro-course Club in the Second Hospital of Jilin University, discusses the means of teacher training for clinical teachers, and shows the application effect of the club. At the same time, the related problems encountered in the process of club construction are summarized and reflected. The construction of MOOC and micro-course clubs is conducive to improving the information-based teaching level of clinical teachers, and also provides new inspiration and ideas for the construction of medical clubs.

Aconitum kusnezoffii is a traditional Chinese medicine of Ranunculaceae family. Its toxicity is relatively strong, and its dosage is similar to that of poisoning. In clinical practice, poisoning events are often caused by excessive dosage or improper use. There is no specific antidote for kusnezoff root poisoning. Severe kusnezoff root poisoning can cause malignant arrhythmia and even death.A case of severe kusnezoff monkshood poisoning was reported in January 2021, which was treated with nificaran hydrochloride for injection in the emergency medicine department of the First Hospital of Handan City. The patient developed ventricular tachycardia, ventricular fibrillation and AS syndrome. In addition to conventional treatment, the patient did not have arrhythmia again after intravenous injection of 25 mg of nifekalan load and continuous pumping of 0.4 mg/kg/h for 7 hours, and did not relapse after discontinuation of nifekalan 24 hours later. It is suggested that the malignant arrhythmia caused by clinical severe kusnezoff monkshood poisoning can be controlled by nifekalan. Whether nifekalan is superior to conventional antiarrhythmic drugs still needs more accumulation and verification of clinical application data.