OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of toripalimab （Tor） combined with chemotherapy （CT） in the treatment of locally advanced or metastatic non-small cell lung cancer （NSCLC）. METHODS PubMed， the Cochrane Library， Embase， Web of Science， CBM， CNKI， Wanfang Data， and Health Technology Assessment （HTA） related websites were searched to collect the HTA reports， systematic reviews/meta-analyses and pharmacoeconomic studies of Tor+CT in the treatment of locally advanced or metastatic NSCLC from database/website inception to March 31， 2025. After data extraction and quality evaluation， the results of the included studies were analyzed descriptively. RESULTS A total of eleven studies were included， involving five systematic reviews/meta-analyses， and six pharmacoeconomic studies. Among the five systematic reviews/ meta-analyses， two were of high quality， while there was one each of moderate， low， and very low quality. All six pharmacoeconomic studies were of good quality. In terms of efficacy， compared with CT， Tor+CT significantly improved patients’ progression-free survival （PFS） and overall survival （P＜0.05）. In addition， compared with ipilimumab+CT， durvalumab， durvalumab+tremelimumab and sugemalimab+CT， Tor+CT could also improve the PFS （P＜0.05）. In terms of safety， there was no significant difference in the incidence of grade≥3 adverse events between patients receiving Tor+CT and CT （P＞0.05）； while Tor+CT had a lower incidence of grade≥3 adverse E-mail： events， compared with camrelizumab+CT， pembrolizumab+ 3233255290@qq.com ipilimumab， nivolumab+CT and atezolizumab+CT （P＜0.05）.In terms of cost-effectiveness， Tor+CT treatment had certain cost-effectiveness advantages， compared with CT. CONCLUSIONS Compared with CT， other programmed death-1/programmed death-ligand 1 inhibitors alone， or their combination with CT， Tor+CT for the treatment of locally advanced or metastatic NSCLC has good efficacy， safety and cost-effectiveness.

Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. Results A total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

The use of nitrification inhibitors has been suggested as a strategy to decrease cadmium(Cd)accumulation in crops.However,the most efficient nitrification inhibitor for mitigating crop Cd accumulation remains to be elucidated,and whether and how changes in soil microbial structure are involved in this process also remains unclear.To address these questions,this study applied three commercial nitrification inhibitors,namely,dicyandiamide(DCD),3,4-dimethylpyrazole phosphate(DMPP),and nitrapyrin(NP),to pakchoi.The results showed that both DCD and DMPP(but not NP)could efficiently decrease Cd concentrations in pakchoi in urea-and ammonium-fertilized soils.In addition,among the three tested nitrification inhibitors,DMPP was the most efficient in decreasing the Cd concentration in pakchoi.The nitrification inhibitors decreased pakchoi Cd concentrations by suppressing acidification-induced Cd availability and reshaping the soil microbial structure;the most effective nitrification inhibitor was DMPP.Ammonia oxidation generates the most protons during nitrification and is inhibited by nitrification inhibitors.Changes in environmental factors and predatory bacterial abundance caused by the nitrification inhibitors changed the soil microbial structure and increased the potential participants in plant Cd accumulation.In summary,our study identified DMPP as the most efficient nitrification inhibitor for mitigating crop Cd contamination and observed that the soil microbial structural changes caused by the nitrification inhibitors contributed to decreasing Cd concentration in pakchoi.

Objective:To investigate the clinicopathologic features of sarcomatoid carcinoma of the pancreas.Methods:The clinicopathological data of 7 cases with sarcomatoid carcinoma of the pancreas admitted in the Affiliated Lihuili Hospital of Ningbo University from September 2013 to August 2021 were retrospectively analyzed, including clinical manifestations, laboratory examination, imaging examination, pathological examination of tissue specimens, surgical methods and adjuvant treatments. Expressions of mesenchymal markers and epithelial markers in tumor tissues were determined by immunohistochemical staining.Results:Among the 7 cases of sarcomatoid carcinoma of the pancreas, there were 4 male and 3 female. The patient age ranged from 51 to 88 years old, and the mean age was 69 years old. All the patients underwent CT examimation before surgery. 3 tumors were located in the head, 3 in the body and 1 in the tail of the pancreas. CT examination also showed that 4 tumors were cystic solid and 3 were cystic. Six patients underwent radical surgery and one underwent partial resection for biopsy. Microscopically, the tumor was predominantly composed of sarcomatoid spindle-shaped cells. Immunohistochemical staining showed that the tumor expressed both mesenchymal markers vimentin and epithelial marker CK7, CK19, CK(pan) and CAM5.2. The overall prognosis of the patients was poor, 4 cases died within 1 year after surgery, and the other 3 cases survived without recurrence.Conclusions:The clinical manifestations of sarcomatoid carcinoma of the pancreas were not typical, but the pathological and immunohistochemical features are obvious and the prognosis is poor.

Purpose To investigate the value of MRI multimodal parameters in predicting sentinel lymph node(SLN)metastasis of breast cancer,and to develop an effective prediction model to reduce the unnecessary biopsy rate of SLN.Materials and Methods Preoperative MRI data of 310 patients with cN0 breast cancer confirmed by operation and pathology in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from January 2019 to December 2021 were retrospectively analyzed,and all patients were divided into positive group and negative group according to whether SLN metastasized.Imaging features of breast lesions were evaluated independently by two radiologists,differences in parameter between the two groups were compared,independent predictors were screened to build models and evaluate diagnostic efficacy.Results The breast lesions in SLN positive group were located in the upper quadrant(χ2=14.94),non-single(χ2=9.29),circular enhancement(χ2=9.23)and the positive rate of adjacent angiogenesis(χ2=9.91)were higher than those in SLN negative group.The lesions in SLN positive group were larger(Z=-2.97,-2.73),and the early enhancement rate was higher(t=-3.48).The minimum apparent diffusion coefficient and relative apparent diffusion coefficient(minimum apparent diffusion coefficient of lesions/apparent diffusion coefficient of glands,rADC)were lower(Z=-7.33,-10.74),all P<0.05.Logistic regression results showed lesion location(OR=4.17,95%CI 1.86-9.35,P=0.001),early enhancement rate(OR=1.01,95%CI 1.00-1.02,P=0.019)and rADC(OR=54.67,95%CI 23.72-126.02,P<0.001)were independent risk factors for SLN metastasis.The model combining lesion location and rADC had the best predictive performance,with a negative predictive value of 96.5%and a 46.1%reduction in unnecessary biopsies.Conclusion SLN preoperative prediction model(lesion location,rADC)based on conventional MRI characteristic parameters has reliable negative prediction value,which is expected to reduce the unnecessary biopsy of nearly half of the patients with stage cN0 breast cancer.

Myocardial dysfunction is the most serious complication of sepsis. Sepsis-induced myocardial dysfunction (SMD) is often associated with gastrointestinal dysfunction, but its pathophysiological significance remains unclear. The present study found that patients with SMD had higher plasma gastrin concentrations than those without SMD. In mice, knockdown of the gastrin receptor, cholecystokinin B receptor (Cckbr), aggravated lipopolysaccharide (LPS)-induced cardiac dysfunction and increased inflammation in the heart, whereas the intravenous administration of gastrin ameliorated SMD and cardiac injury. Macrophage infiltration plays a significant role in SMD because depletion of macrophages by the intravenous injection of clodronate liposomes, 48 h prior to LPS administration, alleviated LPS-induced cardiac injury in Cckbr-deficient mice. The intravenous injection of bone marrow macrophages (BMMs) overexpressing Cckbr reduced LPS-induced myocardial dysfunction. Furthermore, gastrin treatment inhibited toll-like receptor 4 (TLR4) expression through the peroxisome proliferator-activated receptor α (PPAR-α) signaling pathway in BMMs. Thus, our findings provide insights into the mechanism of the protective role of gastrin/CCKBR in SMD, which could be used to develop new treatment modalities for SMD.

In recent years,mechanical thrombectomy has been the most important research progress in the treatment of acute cerebral infarction,especially the positive results of five endovascular therapy studies in 2015 has rewritten its clinical guidelines.However,the focus of these studies was mainly on the small vessel infarction(SVI),and the inclusion criteria of these studies include the following aspects:ASPECTS ≥6 points,Alberta Stroke Program Early CT Score within 6 hours after stroke onset,the infarct volume＜70 mL within 6-24 hours after stroke onset,and the presence of image mismatch or the presence of mismatch between clinical condition and perfusion imaging.The above studies excluded patients with ASPECTS＜6 points or infarct volume ≥70 mL of large core infarction(LCI).With the continuous progress of the endovascular treatment of acute ischemic stroke(AIS),the mechanical thrombectomy therapy strategy has crossed from the"time window"to the"tissue window",meanwhile,the therapeutic goal of mechanical thrombectomy has also moved from treating SVI to a new era of treating LCI that has been a very hot topic recently.Whether endovascular treatment is beneficial for patients with LCI remains uncertain.This paper aims to make a comprehensive review concerning the relevant research progress in endovascular therapy for anterior circulation large core ischemic stroke,including the imaging determination and study inclusion criteria of LCI,the postoperative blood pressure management,and the factors influencing ineffective recanalization and prognosis.(J Intervent Radiol,2023,32:1256-1262)

Objective:To study the characteristics of vaginal microbiota in pregnant women with premature rupture of membranes (PROM) and to establish prediction models for PROM.Methods:This study involved 35 women with preterm premature rupture of membranes (PPROM), 180 with term premature rupture of membranes (TPROM) and 255 term birth cases without premature rupture of membranes (TBWPROM, control group). The V3-V4 hypervariable region sequences in the vaginal samples collected at 16-28 weeks of gestation were detected by 16S rRNA gene next-generation sequencing. The differences in Alpha and Beta diversity, and the attributes and metabolic function prediction of each recognized species among the three groups were analyzed. Subsequently, a random forest model was used to establish the prediction models for PROM using vaginal microbiota species and environmental risk factors.Results:Compared with the control group, the Alpha diversity of the PPROM group was higher (Observed features, P=0.022; Faith_pd index, P=0.024) and Beta diversity was also significantly different (Unweighted UniFrac, P=0.010; Jaccard index, P=0.008). In PPROM cases, Megasphaera genomosp. typeⅠ was significantly increased ( P=0.017) and Lactobacillus mulieris was significantly decreased ( P=0.003). In the patients with TPROM, Megasphaera was significantly increased ( P=0.009) and Lactobacillus mulieris was significantly decreased ( P=0.002). In terms of functional pathways, sulfur oxidation ( P=0.021), methanogenesis from acetate ( P=0.036), L-histidine biosynthesis ( P=0.009), adenosylcobalamin biosynthesis ( P=0.041) and fucose degradation ( P=0.001) were significantly increased in patients with PPROM; L-histidine biosynthesis ( P<0.001) and fucose degradation ( P=0.030) were significantly increased in patients with TPROM. The prediction models were established using the random forest model with vaginal microbiota species and environmental risk factors and the prediction model for PPROM performed well [AUC: 0.739 (95%CI: 0.609-0.869), sensitivity: 0.928, specificity: 0.659, positive predictive value: 0.750, negative predictive value: 0.906], which had a certain reference value. Conclusions:Vaginal microbiota might be related to the development and progression of PROM. Studying the differences in vaginal microbiota might provide a new idea for the prevention and treatment of PROM. Functional prediction provided a direction for further research on the mechanism of PROM. The established prediction model could prevent the occurrence of PPROM and promote maternal and infant health.

Objective:To construct an artificial intelligence-assisted diagnosis system to recognize the characteristics of Helicobacter pylori ( HP) infection under endoscopy, and evaluate its performance in real clinical cases. Methods:A total of 1 033 cases who underwent 13C-urea breath test and gastroscopy in the Digestive Endoscopy Center of Renmin Hospital of Wuhan University from January 2020 to March 2021 were collected retrospectively. Patients with positive results of 13C-urea breath test (which were defined as HP infertion) were assigned to the case group ( n=485), and those with negative results to the control group ( n=548). Gastroscopic images of various mucosal features indicating HP positive and negative, as well as the gastroscopic images of HP positive and negative cases were randomly assigned to the training set, validation set and test set with at 8∶1∶1. An artificial intelligence-assisted diagnosis system for identifying HP infection was developed based on convolutional neural network (CNN) and long short-term memory network (LSTM). In the system, CNN can identify and extract mucosal features of endoscopic images of each patient, generate feature vectors, and then LSTM receives feature vectors to comprehensively judge HP infection status. The diagnostic performance of the system was evaluated by sensitivity, specificity, accuracy and area under receiver operating characteristic curve (AUC). Results:The diagnostic accuracy of this system for nodularity, atrophy, intestinal metaplasia, xanthoma, diffuse redness + spotty redness, mucosal swelling + enlarged fold + sticky mucus and HP negative features was 87.5% (14/16), 74.1% (83/112), 90.0% (45/50), 88.0% (22/25), 63.3% (38/60), 80.1% (238/297) and 85.7% (36 /42), respectively. The sensitivity, specificity, accuracy and AUC of the system for predicting HP infection was 89.6% (43/48), 61.8% (34/55), 74.8% (77/103), and 0.757, respectively. The diagnostic accuracy of the system was equivalent to that of endoscopist in diagnosing HP infection under white light (74.8% VS 72.1%, χ2=0.246, P=0.620). Conclusion:The system developed in this study shows noteworthy ability in evaluating HP status, and can be used to assist endoscopists to diagnose HP infection.