OBJECTIVE To evaluate the efficacy and safety of programmed death-1/programmed death-ligand 1 （PD-1/PD-L1） inhibitors combined with bevacizumab in the treatment of advanced non-small cell lung cancer （NSCLC） based on platinum- containing dual therapy. METHODS Retrieved from CNKI， Wanfang， VIP， Web of Science， PubMed and other Chinese and English databases， cohort studies or randomized controlled trial studies on the treatment of advanced NSCLC with platinum- containing double agents in combination with PD-1/PD-L1 inhibitors and bevacizumab （trial group） versus platinum-containing double agents with or without PD-1/PD-L1 inhibitor or bevacizumab （control group） were collected from the inception to April 25， 2024. After screening literature， extracting data and evaluating quality， meta-analysis and sensitivity analysis were performed by using RevMan 5.4.1 software. RESULTS A total of 15 pieces of literature were included， involving 13 clinical studies with a total of 3 282 patients. Compared with the control group， partial response rate [RR＝0.75，95%CI（0.68，0.82），P＜0.000 01]， complete response rate [RR＝0.47，95%CI（0.29，0.76），P＝0.002]， progressive disease rate [RR＝1.23，95%CI（1.11，1.37），P＜0.000 1]， objective response rate （ORR） [RR＝0.72，95%CI（0.67，0.79），P＜0.000 01] and disease control rate （DCR） [RR＝0.85， 95%CI （0.77，0.95），P＝0.003] were higher in the trial group. There was no statistically significant difference in the stable disease rate [RR＝1.25， 95%CI （0.86， 1.83）， P＝0.25] or overall adverse drug reaction incidence rate [RR＝0.95， 95%CI （0.90， 1.00）， P＝ 0.07] between the two groups of patients. Sensitivity analyses showed robust and reliable results for all outcome indicators. CONCLUSIONS PD-1/PD-L1 inhibitors combined with bevacizumab based on platinum-containing dual therapy in the treatment of advanced NSCLC can improve patients’ clinical benefits， such as ORR and DCR， without increasing the risk of adverse drug reaction.

The paper summarizes the treatment experience of surgical repair combined with automated peritoneal dialysis in a maintenance peritoneal dialysis patient complicated with thoracoabdominal fistula. Through the close participation of medical and patients, the diagnosis method and peritoneal dialysis scheme were optimized continuously. The thoracoabdominal fistula repair operation was successfully implemented by a multidisciplinary team, and the patient's condition was improved and was discharged. This case suggests that standardized diagnosis process and optimized diagnosis method can be applied to improve the sensitivity and specificity of diagnosis, and strive for early diagnosis and intervention; multi-disciplinary teams can be actively formed and the patients can be encouraged to participate in decision-making, to improve treatment confidence; the advantages of automated peritoneal dialysis can be made full use to reduce complications and improve the life quality of the patient.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.

Objective To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods From June 2016 to June 2017,47 patients were diagnosed placenta previa in Union Hospital,Tongji Medical College of Huazhong University of Science and Technology.Posterior wall breakwater-like suture technique was used preferentially,as for cases with poor myometrium layer,lower anterior wall stitch suture was used at the same time.Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results Thirty cases(63.8, 30/47)were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively.Senventeen cases were diagnosed as placenta accreta(36.2%,17/47).Thirty-four cases had the previous history of cesarean section.The average cervical canal length of 47 patients was(2.8±0.9)cm. There were 19 cases(40.4%,19/47)with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47)with 2 or 3 times posterior wall breakwater-like sutured; 12 cases(25.5%,12/47)were treated with anterior wall stitch suture simultaneously.Ten cases(21.3%, 10/47)underwent uterine artery ligation, 17 cases(36.2%, 17/47)underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml,the percentiles 25 was 500 ml,and the percentiles 75 was 1 200 ml.The blood loss≥1 000 ml in 18(38.3%,18/47)patients,and the most serious one was 2 500 ml. The median blood transfusion volume(including allogenetic transfusion and autotransfusion)was 450 ml, the percentiles 25 was 228 ml,and the percentiles 75 was 675 ml.The average vaginal bleeding volume was (150 ± 63)ml first day after operation. The mean hospitalization time was(4.7 ± 1.0)days. The mean gestational weeks of pregnancy termination was(36.1±1.5)weeks,and the mean birth weight of newborns was(2 817±492)g.Apgar score:1-minute 7.8±1.1,5-minute 8.9±0.8.No neonatal death, 16 cases were transferred to neonatal ICU(34.0%, 16/47)mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions Uterine posterior wall breakwater-like suture technique is a simple,safe and effective way in controlling intraoperative bleeding of placental previa. Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy,and improve maternal and fetal prognosis.

The magnamosis device for stage-one repair of the rectovaginal tistula consists of two arc magnets. Drawing the interrupting thread along the fistula margin via the vaginal side, and pulling the string to arrange the magnets at the fistula base along the long axis of the vagina, we made the magnamosis device automatically clipped to seal the fistula. After removing the threads we kept the device for 2-4 weeks till the natural detachment of it when the compressed tissue in between healed after vascular necrosis. This device utilizing the unique ability of magnamosis to fulfill anastomosis under inflammatory infected state reduces the current high relapse rate and colostomy drawbacks of the conventional rectovaginal neoplasty.
Female ; Gynecologic Surgical Procedures ; instrumentation ; methods ; Humans ; Magnetics ; Magnets ; Pressure ; Rectovaginal Fistula ; surgery ; Wound Healing

Objective To compare whether there is a difference in medical cost of intensive care unit(ICU)pa-tients with catheter-associated infection (CAI)between before and after targeted intervention.Methods CAI in ICU patients in 2010(pre-intervention group)and 2013 (post-intervention group)were investigated by retrospective survey,hospitalization cost of two groups of patients before and after intervention was compared.Results The morbidity and mortality in patients with CAI both decreased significantly after intervention,morbidity of healthcare-associated infection(HAI)decreased from 13.47% in 2010 to 4.41 % in 2013,mortality decreased from 10.36% in 2010 to 2.2% in 2103.Total hospitalization cost,blood transfusion cost,and cost of special material before and af-ter the implementation of targeted intervention all significantly different (all P <0.05),the difference of procalcito-nin and antimicrobial agents cost were also significant(all P <0.05).Conclusion Medical cost in ICU patients with CAI decreased after intervention.

Objective To evaluate the treatment of current status and prognosis in childhood APL with APL2008 ,which was administrated since 2008 in our center .Methods A total of 43 children with newly diagnosed APL between 2008 to 2014 were studied retrospectively .Treatment options and current status were summarized from 28 patients who received APL2008 therapy . Results Studied 43 patients were at median age of 8 years and 4 months ,with 28 boys and 15 girls .The main clinical manifestations were infection ,anemia ,bleeding ,fever ,hepatomegaly ,splenomegaly and lymphadenopathy .The proportions of low ,intermediate and high risk groups were 27 .9% ,48 .8% and 23 .3% ,respectively .Eleven cases could be diagnosed as DIC .Bone marrow morphology showed abnormal elevation of promyelocyte .37 patients had distinctive immunophenotype such as frequent expression of CD33 , CD117 and MPO .PML/RARαfusion gene positive rate was 100% in 43 children and cytogenetic analysis were positive in 37 cases , of which specific genetic lesion in APL cells with t (15 ;17)(q22 ;q12) was found in 28 cases ,and karyotypes was found in 9 cases as infrequent chromosomal abnormalities .In 43 patients ,4 cases were early dead from intracranial hemorrhage at early stage ,and 11 cases were given up early .There were only 2 cases dead ,2 cases relapsed and 1 case lost among 28 APL children ,which enabled ef‐ficacy analysis possible .96 .4% of these 28 cases achieved HCR .The 2 year Kaplan Meier estimates of OS and EFS were 85 .9% ± 7 .6% and 80 .4% ± 8 .8% .But OS and EFS would be 94 .7% ± 5 .1% and 88 .9% ± 7 .4% if 3 patients who had non standard treat‐ment were excluded .Conclusion Childhood APL were characterized by anemia ,bleeding ,fever and infiltration .APL′s coincidence rate between PML/RARa fusion gene and morphology ,immunology and cytogenetics were 95 .3% ,90 .2% and 86 .5% ,respective‐ly .APL2008 significantly improved the prognosis of APL .

Objective To analyse the correlation between tone burst auditory brainstem response (tone burst auditory brainstem response,tb-ABR) and CE-Chirp voice evoked auditory steady-state response (auditory steady-state response,CE-Chirp ASSR) in infants with profound sensorineural hearing loss.Methods A total of 45 infants with profound sensorineural hearing loss underwent threshold tone burst ABR and CE-Chirp ASSR of the frequency response test,response thresholds were recorded in 0.5,1.0,2.0 and 4.0 kHz.Whether there was correlation or not existed between two methods were analyzed,SPSS 11.0 statistics software was used.Results Tone burst ABR and CE-Chirp ASSR could lead to different degrees of threshold in each frequency.Response e elicited threshold percentage mainly concentrated in the 91-100 dBnHL,correlation coefficient between 500-4 000 Hz response threshold elicited rate were:0.837,0.913,0.909,and 0.919,respectively (P ＜ 0.001).The difference of the frequency response threshold test between CE-Chirp ASSR and tone burst ABR were not significant (P ＞ 0.05,Chi square).Conclusions The tone burst ABR and CE-Chirp ASSR each frequency have different levels of residual hearing in infants with profound sensorineural hearing loss diagnosed by Click ABR,good correlation exists between tone burst ABR and CE-Chirp ASSR.

Objective To analyze the correlation of real-time fluorescent quantitation PCR(FQ-PCR)for detecting HCV-RNA loading and the chemiluminescence immunoassay(CLIA)for detecting anti-HCV antibody.Methods 587 samples of anti-HCV an-tibody positive detected by CLIA were furteher detected HCV-RNA by FQ-PCR.Results Among 587 samples of anti-HCV anti-body positive by the CLIA screening,225 samples were HCV-RNA negative and 362 samples were HCV-RNA positive detected by FQ-PCR,and the positive rate was 61 .67%,moreover,which was positively correlated with the S/CO ratio detected by CLIA.Con-clusion The positive rate of HCV-RNA is positively correlated with the S/CO ratio detected by CLIA.The result of HCV-RNA can be predicted according to the S/CO ratio.

Objective To evaluate the usefulness of anti -HCV signal-to-cutoff (S/CO)ratio, AST, ALT and the combined examination of anti-HCV S/CO, AST, ALT for predicting HCV RNA results by a model of logistic regression and receiver -operating characteristic (ROC) curve.Methods Five hundred and eighty -eight anti-HCV positive samples were tested by ELISA , followed by RT-PCR to detect HCV-RNA and enzyme rate method to detect AST, ALT.Patients were divided into viremia and non -viremia groups according to HCV-RNA results.Logistic regression and ROC curve analysis was performed to evaluate the diagnostic accuracy of each index for a diagnosis of viremia.Results The serum anti-HCV S/CO ratio, AST, ALT of HCV-RNA positive group were higher than HCV-RNA negative group, showing significant statistical difference ( P <0.05).Anti-HCV S/CO, AST and ALT has a closely posi-tive correlation with HCV-RNA ( P <0.05), anti-HCV S /CO >AST >ALT.The Area Under Curve(AUC) of the combined examina-tion of anti-HCV S/CO ratio, AST and ALT was 0.949(95% confidence interval,0.932 to 0.966), higher than the AUC of anti-HCV S/CO ratio, AST and ALT single index examinations , which was 0.894(95 % confidence interval, 0.862 to 0.926), 0.823(95%confidence interval, 0.789 to 0.856) and 0.788(95% confidence interval, 0.750 to0.826 ) respectively.C onclusions The diag-nostic relevance of the three biochemical markers for predicting the presence of viremia was anti -HCV S/CO ratio >AST >ALT.The combined examination of anti-HCV S /CO ratio, AST and ALT in predicting hepatitis C viremia is superior to any single index examina -tion and it can increase the detecting ability of HCV -RNA greatly.