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

Intestinal aging is central to systemic aging, characterized by a progressive decline in intestinal structure and function. The core mechanisms involve dysregulation of epithelial cell renewal and gut microbiota dysbiosis. In addition to previous results in model organisms like Drosophila melanogaster, recent studies have shown that in mammalian models, aging causes increased intestinal permeability and intestinal-derived systemic inflammation, thereby affecting longevity. Therefore, anti-intestinal aging can be an important strategy for reducing frailty and promoting longevity. There are three key gaps remaining in the study of intestinal aging: (1) overemphasis on aging-related diseases rather than the primary aging mechanisms; (2) lack of specific drugs or treatments to prevent or treat intestinal aging; (3) limited aging-specific dysbiosis research. In this review, the basic structures and renewal mechanisms of intestinal epithelium, and mechanisms and potential therapies for intestinal aging are discussed to advance understanding of the causes, consequences, and treatments of age-related intestinal dysfunction.

Objective This study was to develop a"Spleen Deficiency Certificate Scale for County Residents"and test its reliability.It was then developed as an objective tool for Chinese medicine evidence and symptoms for the prevention and control of chronic diseases among county residents.Methods The scale was compiled based on the team's previous foundation.The reliability of the scale was evaluated using internal consistency reliability and split-half reliability,while its validity was evaluated using structural validity,content validity,calibration validity,and discriminant validity.Results The study included 213 adults from Lanxi,of whom 155 were tested for intestinal flora.Seven scale entries were identified:Fatigue,fear of cold,bland mouth,loss of appetite,diarrhea,weak bowel movements,and tooth-marked tongue.In the reliability test,Cronbach's alpha coefficient was 0.828 and McDonald's ω coefficient was 0.825.The"stomach pain"and"bloating"entries did not meet the inclusion requirements and were recommended to be deleted.The Spearman-Brown coefficient was 0.839.The exploratory factor analysis of the two common factors explained 61.6%of the cumulative variance.The calibration validity indicated that the ratio of salivary amylase activity before and after acid stimulation was 0.826±0.253 in the group with spleen deficiency.Significant differences(P<0.05)in the genera Dialister,Shigella,Leuconostoc,Photobacterium,Trabulsiella,and Parvimonas between the spleen deficiency group and the non-spleen deficiency group.Conclusion The Spleen Deficiency Scale for County Residents demonstrates good reliability and validity.

Objective:To analyze the genetic evolution characteristics of hemagglutinin (HA) and neuraminidase (NA) of influenza B virus in Tongling during 2019-2022 surveillance years.Methods:Twenty-two strains of Victoria influenza B virus isolated from our laboratory during 2019-2022 were selected for whole genome sequencing. The sequence comparison and phylogenetic analysis were conducted by using bioinformatic analysis software.Results:During 2019-2022, seasonal influenza in Tongling City was predominantly caused by influenza B Victoria lineage viruses, which fell within the V1A.3 branch. Among these, 14 strains isolated in the 2021-2022 season were further classified into the V1A.3a.2 sub-branch. Compared with vaccine strains, multiple amino acid mutation sites were detected in both HA and NA proteins of the 22 influenza B Victoria lineage viruses. Notably, all four major antigenic sites (120-loop, 150-loop, 160-helix, and 190-helix regions) in the HA protein exhibited variations. Although no mutations were detected at resistance sites on the NA protein, a change occurred in the glycosylation site at position 197 NETQ in the HA protein.Conclusions:The main amino acid sites of the HA protein of the influenza B Victoria lineage viruses in Tongling City from 2019 to 2022 have undergone significant variation, which may lead to antigenic drift. Therefore, it is essential to strengthen the monitoring of influenza virus mutations.

Objective To analyze the influence of different processing methods,including frying,ginger frying,and salt frying,on the volatile components of A.fructus.Methods The volatile components in different processed products of A.fructus were detected and analyzed by gas chromatography-mass spectrometry(GC-MS)based on multivariate statistical analysis.After OPLS-DA analysis,the different components were screened under the conditions of VIP＞1.5 and P＜0.05 and were qualitatively searched using the NIST 11 spectral library.Results A total of 49 different components were identified,with 14 components only changing in the seed mass and 22 components changing in the peel.The content of camphor could be significantly reduced in the seed mass after A.fructus was processed and the content of bornyl acetate significantly increased in the peel of frying A.fructus.Salt frying had a great influence on the alkanes in A.fructus,and ginger processing did not only increase the volatile components in ginger,which reflected the complexity of the processing mechanism.Conclusion At present,the specific processing mechanism is not clear,but the experimental results provide theoretical data for the "detoxification and efficiency enhancement" effect of A.fructus processing,reflecting the scientific nature of the processing,enriching the processing theory of A.fructus,and providing a reference for further in-depth research on the activity of different processed products of A.fructus.

This article taked the background and relevant systems of the emergence of brain and heart health managers as the starting point, explored their role in the health management of stroke patients, clarified their important role in stroke prevention and treatment and put forward certain thoughts for future development, in order to provide certain reference and guidance for the training mode and role positioning of brain and heart health managers.

Objective:To explore the health behavior of middle-aged and young stroke patients and analyze its influencing factors.Methods:From April to July 2023, convenience sampling was used to select 172 middle-aged and young stroke patients admitted to the First Affiliated Hospital of Naval Medical University as the research subject. A survey was conducted using the General Information Questionnaire, Health Behavior Scale for Stroke Patients, Health Belief Scale, and Multidimensional Scale of Perceived Social Support. Spearman correlation was used to analyze the correlation between health behavior, social support, and health beliefs among middle-aged and young stroke patients. Multiple linear regression was used to analysis the influencing factors of health behavior among middle-aged and young stroke patients. A total of 172 questionnaires were distributed, and 8 questionnaires with missing items and short response times were excluded, and 164 valid questionnaires were collected, with a valid response rate of 95.34%.Results:Among 164 middle-aged and young stroke patients, the total score of the Health Behavior Scale for Stroke Patients was 64.50 (57.00, 80.75), and the average score of the items was 2.58 (2.28, 3.23). Multiple linear regression analysis showed that factors affecting the health behavior of middle-aged and young stroke patients were whether it was the first onset, the time required to reach nearby medical institution, health belief, and social support ( P<0.05) . Conclusions:The health behavior of middle-aged and young stroke patients is above the medium level. In the process of intervening in the health behavior of middle-aged and young stroke patients, medical and nursing staff should pay attention to patients with recurrent stroke and poor access to medical services, while also improving patients' health belief and social support to promote patients' health behavior and reduce stroke recurrence.

Objective:To explore the status quo and influencing factors of self-management behavior in high-risk stroke patients, so as to provide a basis for improving their self-management behavior.Methods:From March to June 2023, convenience sampling was used to select 395 high-risk stroke patients admitted to the First Affiliated Hospital of Naval Medical University as the study subject. A survey was conducted on patients using the General Information Questionnaire, Self-management Behavior Scale for High-risk Stroke Patients, and Cerebral Apoplexy Knowledge Questionnaire. Pearson correlation was used to analyze the correlation between self-management behavior and stroke knowledge. A total of 395 questionnaires were distributed, and unqualified questionnaires (such as regular or repetitive responses, conflicting options before and after) were excluded. Finally, 387 valid questionnaires were collected, with an effective response rate of 97.97%.Results:The score of the Self-management Behavior Scale for High-risk Stroke Patients for 387 high-risk stroke patients was (137.60±25.47), with a score indicator of 62.53%, which was at a moderate level. The score of the Cerebral Apoplexy Knowledge Questionnaire was (19.26±10.19), which was at a low level. The random forest algorithm showed that the importance order of influencing factors was stroke knowledge, number of ways to obtain health information, educational level, number of risk factors, frequency of physical examinations, medical insurance, age, work situation, and gender. The Lasso regression indicated that there were four influencing factors corresponding to the minimum error. The top four factors in importance were included in multiple linear regression, and the results showed that educational level, number of risk factors, number of ways to obtain health information, and stroke knowledge were the influencing factors of self-management behavior in high-risk stroke patients ( P<0.05) . Conclusions:The self-management behavior of high-risk stroke patients was at a moderate level. Medical and nursing staff should strengthen stroke knowledge education, provide personalized education for different risk factors, and improve the self-management of the target population to reduce the incidence of stroke.

Objective:To explore the mediating effect of coping style on disease perception and pre-hospital delayed behavioral intention in patients with acute ischemic stroke.Methods:This study was a cross-sectional study. From February to July 2023, convenience sampling was used to select 205 patients with acute ischemic stroke admitted to the First Affiliated Hospital of Naval Medical University as the study subject. The survey was conducted using the General Information Questionnaire, Stroke Pre-Hospital Delay Behavior Intention, Brief Illness Perception Questionnaire, and Simplified Coping Style Questionnaire.Results:205 questionnaires were filled out, 195 valid questionnaires, and the validity rate of the questionnaire was 95.1%. The Stroke Pre-Hospital Delay Behavior Intention score of patients with acute ischemic stroke was (63.61±16.12). Pre-hospital delayed behavioral intention in patients with acute ischemic stroke was positively correlated with disease perception and negative coping ( r=0.360, 0.266; P<0.01), and negatively correlated with positive coping ( r=-0.279, P<0.01). The mediating effects of positive and negative coping on disease perception and pre-hospital delayed behavioral intention in ischemic stroke patients were 0.111 and 0.097, respectively, accounting for 26.89% and 23.49% of the total effect. Conclusions:There is a partial mediating effect of coping strategies between disease perception and pre-hospital delayed behavioral intention in ischemic stroke patients. In the process of stroke management, medical and nursing staff can reduce pre-hospital delayed behavioral intentions by improving disease cognition and coping style.

Objective:To design and develop a WeChat mini-program for risk assessment and health management of people at high-risk of stroke.Methods:Relying on the network platforms and smartphones, a WeChat mini-program based health management network platform was designed and developed based on the analysis of the needs of high-risk stroke populations and medical staff for the management of high-risk stroke populations, with health data collection, stroke risk assessment, health education and knowledge base matching and intervention programs and data privacy and security as the key technologies.Results:The mini-program included three ports, such as the patient end, medical staff end and backend management end. It had the main functions of stroke risk assessment, intelligent promotion of health management follow-up plans, recording of health indicators and medication reminders, interactive consultation, and health knowledge promotion.Conclusions:The development of risk assessment and health management WeChat mini-program for high-risk stroke populations and the use of a simple and effective intelligent assessment to realize rapid classification of stroke risk in population lay a foundation for the WeChat mini-program function module to carry out individualized, accurate and efficient brain-heart health management.