Anti-PD1/PD-L1 monotherapy vs standard of care in patients with recurrent or metastatic head and neck squamous cell carcinoma: A meta-analysis of randomized controlled trials

Background:In recent years, a number of clinical trials for antibody drugs targeting programmed cell death protein 1 (PD1)/programmed cell death 1 ligand 1 (PD-L1) have been carried out on recurrent or metastatic head and neck squamous cell carcinoma (R/M SCCHN) and reported promising prospects. To further evaluate and understand the effects and risk of anti-PD1/PD-L1 monotherapy vs standard of care (SoC) in R/M SCCHN, we conducted this meta-analysis of published randomized controlled trials.Method:The potential eligible trials were searched from Cochrane library and Pubmed and Embase databases. Randomized controlled trials evaluating the effects and risk of anti-PD1/PD-L1 monotherapy vs SoC in platinum refractory R/M SCCHN were selected. The outcomes, including objective response rate, disease control rate, progression-free survival, overall survival, and treatment-related adverse events, were extracted and pooled.Results:1345 patients with R/M SCCHN from three randomized controlled trials were enrolled in this analysis. Compared with SoC, anti-PD1/PD-L1 monotherapy could provide statistically significant overall survival benefit, hazard ratio (95% confidence interval ) = 0.79 [0.70–0.90]. However, we observed no significant difference between 2 treatments in progression-free survival (hazard ratio [95% confidence interval] = 0.96 [0.85–1.09]). Furthermore, anti-PD1/PD-L1 monotherapy caused less treatment-related adverse events than standard of care.Conclusion:Anti-PD1/PD-L1 monotherapy could indeed reduce the risk of death in R/M SCCHN patients, and provide higher safety vs SoC. Expression level of PD-L1 may be a useful biomarker for selecting patients with better response to anti-PD1/PD-L1 monotherapy.     

自制中药熏洗对混合痔术后病人切口愈合影响

目的 观察自制中药熏洗配合换药对混合痔术后病人切口愈合情况的影响。方法 将256例混合痔术后病人随机分为治疗组和对照组。治疗组128例病人采用自制中药熏洗加局部换药治疗,每日1次;对照组128例病人采用250 g/L的硫酸镁坐浴后局部换药治疗,每日1次。结果 治疗后治疗组病人症状消失时间及切口愈合时间较对照组明显缩短,差异有显著性（t=16.43～24.95,P〈0 0.1）。结论 自制中药熏洗可以有效地减少混合痔术后病人的不良反应,促进切口愈合。     

超滤曲线与钠曲线联合应用对透析相关低血压的影响

目的探讨超滤曲线与钠曲线联合应用对血液透析相关低血压的影响。方法20例维持性血液透析易发生低血压患者,其中男性9例,女性11例;年龄25—68岁,平均年龄44岁;体质量46．0～72．5kg,平均体质量59．9kg。随机分为试验组和对照组,每组10例（试验组男：女为4：6;对照组男：女为5：5）。分别给予超滤曲线与钠曲线结合透析（试验组）和标准模式透析（对照组）1个月（共12次）,比较两组患者透析前血压、透析过程中血压及低血压的发生率、透析前后血清钠浓度。结果试验组与对照组超滤量及透析间期体质量增长差异无统计学意义（P〉0．05）;两组之间透析前及透析1h、透析2h血压变化差异无统计学意义（P〉0．05）,试验组在透析3h、透析4h血压高于对照组,差异有统计学意义（P〈0．05）;透析过程中,试验组低血压发生率17％,对照组为41％,差异有显著统计学意义（P〈0．01）,透析4h,试验组和对照组血清钠浓度差异无统计学意义（P〉0．05）。结论超滤曲线与钠曲线结合透析可以有效预防透析相关低血压的发生,而对血清钠离子浓度无明显影响。     

Expert consensus on the clinical application of totally implantable venous access devices in the upper arm (2022 Edition)

With the widespread adoption of ultrasound guidance, Seldinger puncture techniques, and intracardiac electrical positioning technology for the placement of peripherally inserted central catheters in recent years, an increasing number of medical staff and patients now accept peripheral placement of totally implantable venous access devices (TIVADs) in the upper arm. This approach has the advantage of completely avoiding the risks of hemothorax, pneumothorax, and neck and chest scarring. Medical specialties presently engaged in this study in China include internal medicine, surgery, anesthesiology, and interventional departments. However, command over implantation techniques, treatment of complications, and proper use and maintenance of TIVAD remain uneven among different medical units. Moreover, currently, there are no established quality control standards for implantation techniques or specifications for handling complications. Thus, this expert consensus is proposed to improve the success rate of TIVAD implantation via the upper-arm approach, reduce complication rates, and ensure patient safety. This consensus elaborates on the technical indications and contraindications, procedures and technical points, treatment of complications, and the use and maintenance of upper-arm TIVAD, thus providing a practical reference for medical staff.     

A cross-sectional study of clinical emergency department nurses’ occupational stress,job involvement and team resilience

IntroductionThe occupational stress of clinical nurses has drawn increasing attention. It has been proven that occupational stress is related to job involvement, and job involvement affects team resilience. However, research on the relationship between emergency nurses’ occupational stress, job involvement and team resilience is lacking.AimTo explore relationships between occupational stress, job involvement, and team resilience among a sample of emergency nurses and determined significant influencing factors of occupational stress in emergency departments.MethodsIn four hospitals in Shandong, China, 187 emergency room nurses participated in a study. The Utrecht Work Engagement Scale, the Chinese version of the Stressors Scale for Emergency Nurses, and a scale for evaluating the team resilience of medical professionals were used to collect data.ResultsThe overall occupational stress score of nurses working in the emergency departments in Shandong province was 81.07 ± 25.80. The results of Single-factor analysis demonstrated that the scores indicating the occupational stress for emergency nurses differed significantly with respect to age, education level, marital status, children, professional title, work experience and work shift (P < 0.05). Additionally, there is a negative correlation between job involvement and team resilience and occupational stress. Multiple linear regression results showed that the job involvement, team resilience and work shift were statistically significant influencing factors of the level of occupational stress (change R² = 17.5 %, F = 5.386, P < 0.001).ConclusionsStronger team resilience and more active job involvement resulted in lower occupational stress levels experienced by emergency nurses.     

Successful aging and environmental factors in older individuals in urban and rural areas: A cross-sectional study

ObjectiveThe effects of the environmental factors on successful aging (SA) are not well understood. This study aimed to assess SA and related factors in older individuals in urban and rural areas, exploring differences between groups and investigating the effects of environmental factors.MethodsThis was a cross-sectional study of 205 and 212 older people in urban and rural areas of Shandong Province, respectively, between March 2019 and September 2019. SA was measured using the Successful Aging Inventory (SAI). The environmental factors were assessed using the WHOQOL-100 scale. Univariable and multivariable analyses were performed to determine associations of different parameters with SA.ResultsThe scores of SA and environmental factors of older individuals in urban vs. rural areas were 48.79 vs. 46.14 and 128.63 vs. 107.81, respectively (both P < 0.05). All “Environment” dimensions (“Safety and physical security”, “Home environment”, “Financial resources”, “Health and social care”, “Opportunities for acquiring new information and skills”, “Participation and opportunities for leisure”, and “Transport”), except “Physical environment (pollution/noise/traffic/climate)”, were associated with SA (all P < 0.05). Multiple linear regression showed that psychological resilience, physical activity, self-evaluation of SA, environment, social support, and hearing status were shared factors by the urban and rural older individuals.ConclusionThe SA and environmental factor scores were higher in urban older individuals compared with rural ones. Environment dimensions (except “Physical environment (pollution/noise/traffic/climate)”) were associated with SA.