Objective:To explore the impact of pembrolizumab combined with chemotherapy on angiogenesis and circulating endothelial cells in patients with advanced non-small cell lung cancer (NSCLC) .Methods:The retrospective analysis of clinical data from 121 patients diagnosed with advanced NSCLC who were admitted to the Second Affiliated Hospital of Xingtai Medical College from August 2021 to January 2023 was conducted. These patients were divided into a control group ( n=57) and an observation group ( n=64) based on the designated treatment protocol. Specifically, individuals in the control group received standard chemotherapy (cisplatin+paclitaxel), while those in the observation group underwent penpilimab therapy in conjunction with conventional chemotherapy. The comparative assessment encompassed short-term clinical efficacy, quality of life, immune function parameters, angiogenic factors [including endostatin, insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF) ], circulating endothelial cells, and adverse reactions within the two groups. Results:After 6 courses of treatment, the objective response rate [67.19% (43/64) vs. 49.12% (28/57) ] and disease control rate [87.50% (56/64) vs. 70.18% (40/57) ] in observation group were higher than those in control group, with statistically significant differences ( χ2=4.06, P=0.044; χ2=5.52, P=0.019). The quality of life score of observation group [ (56.77±6.81) points] was significantly higher than that of control group [ (47.73±8.23) points], with a statistically significant difference ( t=6.61, P<0.001) ; The T cell subgroup CD3 + levels [ (63.59±9.00) % vs. (53.06±8.80%), t=6.49, P<0.001], CD4 + levels [ (46.54±8.20) % vs. (30.74±7.32) %, t=11.13, P<0.001] and CD4 +/CD8 + ratio (1.90±0.36 vs. 1.21±0.28, t=11.66, P<0.001) in observation group were significantly higher than those in control group, with statistically significant differences; Endostatin in observation group [ (48.99±3.43) μmol/L] was significantly higher than that in control group [ (31.35±3.87) μmol/L], with a statistically significant difference ( t=26.58, P<0.001), IGF-1 [ (102.31±20.35) μg/L vs. (134.98±19.02) μg/L] and VEGF [ (31.70±4.32) pg/ml vs. (58.71±5.99) pg/ml] were significantly lower in observation group than those in control group, with statistically significant differences ( t=18.73, P<0.001; t=28.14, P<0.001). The number of circulating endothelial cells in observation group [ (58.77±10.03) /ml] was significantly lower than that in control group [ (87.01±8.01) /ml], with a statistically significant difference ( t=17.20, P<0.001). During treatment, there were no statistically significant differences in the incidence of gastrointestinal reaction ( χ2=0.01, P=0.908), leukopenia ( χ2=0.64, P=0.424), thrombocytopenia ( χ2=0.28, P=0.597), anemia ( χ2=1.66, P=0.197), nephrotoxicity ( χ2=0.64, P=0.424), skin rash ( χ2=1.33, P=0.249) between the two groups. Conclusion:The combination therapy of pembrolizumab and chemotherapy for the treatment of advanced NSCLC has demonstrated noteworthy effectiveness. This regimen has the potential to enhance patients' immune functionality, ameliorate their overall quality of life, suppress angiogenesis, and exhibits a commendable profile of safety and reliability.

Objective To design a search and rescue UAV that is portable and user-friendly in order to meet the needs of rescue personnel on the battlefield.Methods Three-dimensional design software CATIA was used to complete the structural design of the UAV body.In order to make full use of the internal space of the UAV body,folding wings were adopted to reduce the volume of the UAV.By using ABAQUS,the finite elements of the key parts of the UAV were analyzed before the modal analysis of the whole vehicle was conducted to verify the reliability of the structure.The robot simulation software Webots was used for motion simulation of the UAV.Results Simulation analysis and test verification suggested that the structural design of the UAV was well-grounded.It could be quickly and properly deployed by means of hand launch or barrels,which made it easier for rescuers to use the UAV.Conclusion The design and simulation research of UAVs with portable folding wings for search and rescue is of great significance for the research and development of physical prototypes.This study is expected to stimulate new ideas for the development of rescue equipment in the PLA,and contribute to miniaturization of UAVs.

Objective:To investigate the risk factors and their warning effectiveness for postoperative intestinal barrier dysfunction (IBD) in patients with severe traumatic brain injury (sTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 101 patients with sTBI admitted to Wuxi Branch of Zhongda Hospital Affiliated to Southeast University from May 2020 to February 2023, including 63 males and 38 females, aged 21-81 years [(53.4±14.2)years]. All the patients underwent emergency surgery. The patients were divided into IBD group ( n=67) and non-IBD group ( n=34) according to whether or not they had IBD after surgery. The gender, age, basic diseases (hypertension and diabetes), types of intracranial hematoma (subdural, epidural, and intracerebral hematoma), preoperative Glasgow Coma Scale (GCS), cerebral hernia, intraoperative initial intracranial pressure (iICP), operation time, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were recorded in the two groups. Univariate and multivariate binary Logistic regression analyses were conducted to assess the correlations between above-mentioned indicators and incidence of postoperative IBD in sTBI patients and determine the independent risk factors for sTBI. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the warning effectiveness of each risk factor for IBD. Results:The results of the univariate analysis showed that preoperative GCS, cerebral hernia, intraoperative iICP, removal of bone flap, treatment time in ICU, initiation time of enteral nutrition, and use of broad-spectrum antibiotics were significantly correlated with the incidence of IBD in sTBI patients ( P<0.05 or 0.01), while there were no correlations of IBD with gender, age, basic diseases, types of intracranial hematoma and operation time ( P>0.05). The results of the multivariate binary Logistic regression analysis showed that preoperative GCS≤5 points ( OR=2.49, 95% CI 1.17, 5.32, P<0.05), intraoperative iICP>23 mmHg (1 mmHg=0.133 kPa)( OR=1.20, 95% CI 1.03, 1.39, P<0.05), and initiation time of enteral nutrition>24 hours ( OR=10.03, 95% CI 1.26, 80.21, P<0.05) were highly correlated with postoperative IBD in sTBI patients. The results of the ROC curve analysis showed that intraoperative iICP had the highest warning value (AUC=0.91, 95% CI 0.85, 0.96), followed by preoperative GCS (AUC=0.88, 95% CI 0.82, 0.95), and initiation time of enteral nutrition had the lowest warning value (AUC=0.78, 95% CI 0.69, 0.87). Conclusions:Preoperative GCS≤5 points, intraoperative iICP>23 mmHg, and initiation time of enteral nutrition>24 hours are independent risk factors for postoperative IBD in sTBI patients. The warning value of intraoperative iICP ranks the highest for postoperative IBD in sTBI patients, followed by preoperative GCS, with initiation time of enteral nutrition having the lowest warning value.

Objective: Evidence supports the efficacy of coronary computed tomography angiography (CCTA)-based risk scores in cardiovascular risk stratification of patients with suspected coronary artery disease (CAD). We aimed to compare two CCTAbased risk score algorithms, Leiden and Confirm scores, in patients with diabetes mellitus (DM) and suspected CAD. Materials and Methods: This single-center prospective cohort study consecutively included 1241 DM patients (54.1% male, 60.2 ± 10.4 years) referred for CCTA for suspected CAD in 2015–2017. Leiden and Confirm scores were calculated and stratified as < 5 (reference), 5–20, and > 20 for Leiden and < 14.3 (reference), 14.3–19.5, and > 19.5 for Confirm. Major adverse cardiovascular events (MACE) were defined as the composite outcomes of cardiovascular death, nonfatal myocardial infarction (MI), stroke, and unstable angina requiring hospitalization. The Cox model and Kaplan–Meier method were used to evaluate the effect size of the risk scores on MACE. The area under the curve (AUC) at the median follow-up time was also compared between score algorithms. Results: During a median follow-up of 31 months (interquartile range, 27.6–37.3 months), 131 of MACE were recorded, including 17 cardiovascular deaths, 28 nonfatal MIs, 64 unstable anginas requiring hospitalization, and 22 strokes. An incremental incidence of MACE was observed in both Leiden and Confirm scores, with an increase in the scores (log-rank p < 0.001). In the multivariable analysis, compared with Leiden score < 5, the hazard ratios for Leiden scores of 5–20 and > 20 were 2.37 (95% confidence interval [CI]: 1.53–3.69; p < 0.001) and 4.39 (95% CI: 2.40–8.01; p < 0.001), respectively, while the Confirm score did not demonstrate a statistically significant association with the risk of MACE. The Leiden score showed a greater AUC of 0.840 compared to 0.777 for the Confirm score (p < 0.001). Conclusion CCTA-based risk score algorithms could be used as reliable cardiovascular risk predictors in patients with DM and suspected CAD, among which the Leiden score outperformed the Confirm score in predicting MACE.

Objective:To develop a pretest probability model of obstructive coronary artery disease with machine learning based on multi-site Chinese population data.Methods:Chinese regiStry in early deTection and Risk strAtificaTion of coronary plaques (C-Strat) study is a prospective multi-center cohort study, in which consecutive patients with suspected obstructive coronary artery disease and ≥64 detector row coronary computed tomography angioplasty (CCTA) evaluation were included. Data from the patients were randomly split into a training set (70%) and a test set (30%). More than 50% of coronary artery stenosis by CCTA was defined as positive outcome. A boosted ensemble algorithm (XGBoost), 10-fold cross-validation and Bayesian optimization were used to establish a new prediction model-CARDIACS(pretest probability model from Chinese registry in eARly Detection and rIsk stratificAtion of Coronary plaques Study), and a logistic regression was used to establish a model-LOGISTIC in training set. The test set was used for validation and comparison among CARDIACS, LOGISTIC, UDFM (updated Diamond-Forrester Model) and DFCASS(Diamond-Forrester and CASS).Results:The study population included 29 455 patients with age of (57.0±9.7) years and 44.8% women, of whom 19.1% (5 622/29 455) had obstructive coronary artery disease. For CARDIACS, the age, the reason for visit and the body mass index (BMI) were the most important predictive variables. In the independent test set, the area under the curve (AUC) of CARDIACS was 0.72 (95% CI 0.70-0.73), which was significantly superior to that of LOGISTIC (AUC 0.69, 95% CI 0.68-0.71, P=0.015), UDFM (AUC 0.64, 95% CI 0.62-0.65, P<0.001) and DFCASS (AUC 0.66, 95% CI 0.64-0.67, P<0.001), respectively. Conclusion:Based on Chinese population, the study developed a new pretest probability model--CARDIACS, which was superior to the traditional models. CARDIACS is expected to assist in the clinical decision-making for patients with stable chest pain.

Objective:To explore the value of application and manipulation technique of neuroendoscope in microsurgical clipping of ruptured posterior communicating artery(PCoA)aneurysms via keyhole approaches.Methods:From January 2018 to December 2020, the clinical data of 52 patients who received microsurgical clipping for ruptured via keyhole approach were retrospectively analysed. Forty-one patients had the intraoperative endoscopic monitoring. The supraorbital keyhole approach or pterional keyhole approach was applied based on the characteristics of the aneurysms. According to the in-surgery requirement, a 30° rigid neuroendoscope was used before and/or after clipping. All patients entered postoperative follow-up in outpatient clinic and were evaluated with the modified Rankin Scale(mRS).Results:All 52 patients had 52 ruptured PCoA aneurysms. Eighteen of the patients were treated via supraorbital keyhole approach and 34 via pterion keyhole approach. Pre-and post-clipping endoscopic observation were carried out in 12 cases and 29 only with post-clipping endoscopic observation. Residual aneurysmal neck was detected in 3 patients. Missed clipping of perforators was found in 2 patients and followed by proper adjustment of clips. All patients received follow-up angiographic examinations. Total obliteration of the aneurysm and an intact of internal carotid artery and PCoA were found in 41 patients by the intraoperative endoscopic observation. Two residual aneurysmal neck were detected in 11 patients without intraoperative endoscopic observation. After 11 to 45 months of follow-up, all patients had good recovery(mRS 0-1).Conclusion:It is a safe and effective method with endoscopic observation during microsurgical clipping procedure for ruptured PCoA aneurysms via keyhole approaches. It can effectively make up for the insufficient visual angle of microscope, realise the anatomical relationship between the aneurysm and adjacent structures, and avoid residual aneurysmal neck and an iatrogenic injury to the parent artery and perforators.

Objective    To analyze the safety and feasibility of the adhesion dissection in transaxillary uniportal thoracoscopy for palmar hyperhidrosis. Methods    Data of 168 patients, including 77 males and 91 females with an average age of 14 - 41 (24.3±5.4) years, who received transaxillary uniportal video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis from January 2015 to July 2018 were retrospectively analyzed. Severe adhesion was found in 4 patients and mild adhesion was found in 12 patients. Artificial pneumothorax was used to help dissect adhesion. Preoperative CT scan could help locate the rib according to the relative position to azygos vein or aotic arch. Results    All of 168 patients were successfully completed with transaxillary uniportal VATS. Then chest tubes were put in the 4 severe adhesion patients. The tube was removed from one patient after 11 days because of air leak, and from the other three patients on the next day. The other 164 patients with or without adhesion were discharged from hospital on the operation day or the next day. Conclusion    Adhesion dissection in transaxillary uniportal VATS for palmar hyperhidrosis is safe and feasibile.

Betacoronavirus ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; Single-Cell Analysis

Objective:To investigate the effect of jugular tubercle thickness on pathogenesis of hemifacial spasm (HFS) and its curative efficacy by microvascular decompression (MVD).Methods:One hundred and thirty-five HFS patients accepted MVD in our hospital from June 2017 to May 2018 were enrolled in this study. The thickness of the jugular tubercle was measured on preoperative magnetic resonance imaging (MRI) with steady state acquisition (FIESTA) sequence. The differences of jugular tubercle thickness and arterial flow rate from the jugular tubercle to the brainstem between the healthy side and symptomatic side in these patients were compared. These patients were divided into immediate symptom-relief group ( n=112) and symptom residual group ( n=23) according to the symptom relief one d after MVD; the difference of jugular tubercle thickness between the two groups were compared. Results:No significant difference in the jugular tubercle thickness was noted between the healthy side and the symptomatic side in all 135 patients ( t=0.787, P=0.432). The arterial flow rate from the jugular tubercle to the brainstem in the symptomatic side (95.6%) was significantly higher than that in the healthy side (57.0%, P<0.05). The jugular tubercle thickness in the symptomatic residual group ([5.13±2.19] mm) was significantly higher than that in the immediate symptom-relief group ([4.03±1.16] mm, t=2.114, P=0.0396). Conclusion:The thickness of jugular tubercle is not associated with HFS onset, but may affect the immediate outcome of MVD.

Objective To increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS) right upper lobectomy. Methods Data of 97 consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec, 2014 to Dec, 2017. There were 41 males and 56 females at age of 26–79 (57.8±10.6) years. The hilar structure was cut from posterior to anterior one by one. The mediastinal lymph nodes were dissected if lung cancer was diagnosed. Results Ninety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach, 3 of them were completed with posterior approach combined with anterior approach, and 1 of them needed thoracotomy. The mean operative time was 76–192 (127.0±32.0) min. The thoracic drainage time was 2–20 (3.4±2.7) d. The postoperative length of hospital stay was 3–23 (5.4±3.1) d. There were postoperative complications in 7 patients and no postoperative mortality. Conclusion Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible, which can decrease the fatigue of both the surgeon and the assistant. It also provides with better exposure of posterior mediastinum, less dragging lung, and less interference of the instruments and help keep the clear surgical field. In complicated cases, posterior approach could combine with anterior approach to complete the VATS lobectomy.