AMIGO2 attenuates innate cisplatin sensitivity by suppression of GSDME-conferred pyroptosis in non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer. Cisplatin is commonly used in the treatment of many malignant tumours including NSCLC. The innate drug sensitivity greatly affects the clinical efficacy of cisplatin-based chemotherapy. As a plasma membrane adhesion molecule, amphoterin-induced gene and ORF-2 (AMIGO2) initially identified as a neurite outgrowth factor has been recently found to play a crucial role in cancer occurrence and progression. However, it is still unclear whether AMIGO2 is involved in innate cisplatin sensitivity. In the present study, we provided the in vitro and in vivo evidences indicating that the alteration of AMIGO2 expression triggered changes of innate cisplatin sensitivity as well as cisplatin-induced pyroptosis in NSCLC. Further results revealed that AMIGO2 might inhibit cisplatin-induced activation of (caspase-8 and caspase-9)/caspase-3 via stimulating PDK1/Akt (T308) signalling axis, resulting in suppression of GSDME cleavage and the subsequent cell pyroptosis, thereby decreasing the sensitivity of NSCLC cells to cisplatin treatment. The results provided a new insight that AMIGO2 regulated the innate cisplatin sensitivity of NSCLC through GSDME-mediated pyroptosis.

Specific changes and clinical significance of plasma D-dimer during pregnancy and puerperium: a prospective study.

BACKGROUND: Pregnant and puerperal women are high-risk populations for developing venous thromboembolism (VTE). Plasma D-dimer (D-D) is of good value in the diagnosis of exclusion of VTE in the nonpregnant population. Since there is no consensus reference range of plasma D-D applicable to pregnant and puerperal women, the application of plasma D-D is limited. To investigate the change characteristics and the reference range of plasma D-D levels during pregnancy and puerperium and to explore the pregnancy- and childbirth-related factors affecting plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. METHODS: A prospective cohort study was conducted with 514 pregnant and puerperal women (cohort 1), and 29 puerperal women developed VTE 24-48 h after caesarean section (cohort 2). In cohort 1, the effects of the pregnancy- and childbirth-related factors on the plasma D-D levels were analyzed by comparing the differences in plasma D-D levels between different groups and between different subgroups. The 95th percentiles were calculated to establish the unilateral upper limits of the plasma D-D levels. The plasma D-D levels at 24-48 h postpartum were compared between normal singleton pregnant and puerperal women in cohort 2 and women from the cesarean section subgroup in cohort 1, binary logistic analysis was used to analyze the relevance between plasma D-D level and the risk of VTE developing 24-48 h after caesarean section, and a receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section. RESULTS: The 95% reference ranges of plasma D-D levels in the normal singleton pregnancy group were ≤ 1.01 mg/L in the first trimester, ≤ 3.17 mg/L in the second trimester, ≤ 5.35 mg/L in the third trimester, ≤ 5.47 mg/L at 24-48 h postpartum, and ≤ 0.66 mg/L at 42 days postpartum. The plasma D-D levels of the normal twin pregnancy group were significantly higher than those of the normal singleton pregnancy group during pregnancy (P < 0.05), the plasma D-D levels of the GDM group in the third trimester were significantly higher than those of the normal singleton pregnancy group (P < 0.05). The plasma D-D levels of the advanced age subgroup at 24-48 h postpartum were significantly higher than those of the nonadvanced age subgroup (P < 0.05), and the plasma D-D levels of the caesarean section subgroup at 24-48 h postpartum were significantly higher than those of the vaginal delivery subgroup (P < 0.05). The plasma D-D level was significantly correlated with the risk of VTE developing at 24-48 h after caesarean section (OR = 2.252, 95% CI: 1.611-3.149). The optimal cut-off value of plasma D-D for the diagnosis of exclusion of VTE during early puerperium after caesarean section was 3.24 mg/L. The negative predictive value for the diagnosis of exclusion of VTE was 96.1%, and the area under the curve (AUC) was 0.816, P < 0.001. CONCLUSIONS: The thresholds of plasma D-D levels in normal singleton pregnancy and parturient women were higher than those of nonpregnant women. Plasma D-D had good value in the diagnosis of exclusion of VTE occurring during early puerperium after caesarean section. Further studies are needed to validate these reference ranges and assess the effects of pregnancy- and childbirth-related factors on plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during pregnancy and puerperium.

Association between post-stroke smoking and stroke recurrence in first-ever ischemic stroke survivors: based on a 10-year prospective cohort.

BACKGROUND: Whether smoking is a risk factor for ischemic stroke (IS) recurrence in IS survivors is still uncovered, and evidences are sparse. Meanwhile, an add-on effect of clopidogrel was observed in myocardial infarction patients who smoked, but whether the paradox exists in IS patients is still unsolved. The objectives of this study are to explore the association between smoking behavior after index stroke and IS recurrence and to explore whether the paradox exists. METHODS: A prospective cohort of first-ever IS patients was conducted between 2010 and 2019. The prognosis and smoking features of enrolled patients were obtained via telephone follow-up every 3 months. Fine-gray model with interaction terms was applied to measure the relationships between stroke recurrence and smoking behaviors after index stroke and to explore the add-on effect of clopidogrel in smoking patients. RESULTS: There were 171 (24.26%) recurrences and 129 (18.30%) deaths during follow-up in 705 enrolled IS patients. One hundred forty-six (20.71%) patients smoked after index stroke. The hazard ratios (HRs) and 95% confidence intervals (CIs) of interaction terms between antiplatelet drug and follow-up smoking (smoking status and daily smoking amount) were 1.092 (95% CI: 0.524, 2.276) and 0.985 (95% CI: 0.941, 1.031), respectively. A significantly higher risk of recurrence was observed in patients with a higher daily smoking amount during follow-up (per cigarette), with HR being 1.027 (95% CI: 1.003, 1.052). CONCLUSIONS: Smoking could elevate the risk of IS recurrence, and IS survivor should be advised to quit or smoke less. Add-on effect of clopidogrel may not exist in smoking strokers taking clopidogrel.

[Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Predicting Preeclampsia During Pregnancy].

Objective: To investigate the changes of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with normal pregnancy women and pregnant women with preeclampsia (PE) and the value of using NLR and PLR in the first trimester to predict PE. Methods: We retrospectively collected the clinical data of 485 pregnant women (97 had PE and 388 were of normal pregnancy) who were admitted to West China Second University Hospital and had their babies delivered there between January 1 and December 31, 2016 and 30 healthy women who were not pregnant and who had physical examination at the hospital over the same period. The subjects' NLR and PLR were calculated and compared. Logistic regression analysis was done to study the risk factors of PE, and the receiver operating characteristic curves were used to assess the value of using NLR and PLR in the first trimester to predict PE. Results: There was no significant difference in NLR or PLR between the PE group and the normal pregnancy group in the first, second and third trimesters. Compared with that of the normal non-pregnant group, the NLR of the PE group and the normal pregnancy group started to rise in the first trimester, reached the maximum in the second trimester, and decreased in the third trimester; PLR started to decrease in the second trimester and reached the lowest level in the third trimester, exhibiting significant differences ( P<0.05). In the three trimesters, NLR and PLR were not associated with the severity of PE, maternal age, or pre-pregnancy BMI. The predictive model combining factors including pre-pregnancy obesity, advanced maternal age, and nulliparity showed an area under the curve ( AUC) of 0.84 for predicting PE. When NLR in the first trimester or PLR in the first trimester were added to the combined model of pre-pregnancy obesity, advanced maternal age, and nulliparity, the AUC subsequently derived were both 0.85. Conclusion: NLR and PLR are not independent influencing factors of PE and cannot improve the predictive value for PE.

Identification of a crucial amino acid responsible for the loss of specifying FGFR1-KLB affinity of the iodinated FGF21.

Previous studies suggest that specific binding to the complex consisting of fibroblast growth factor receptor-1 (FGFR1) and the coreceptor beta-Klotho (KLB) is the premise for human FGF19 and FGF21 activating the downstream signaling cascades, and regulating the metabolic homeostasis. However, it was found that human FGF21 loses its ability to bind to FGFR1-KLB after iodination with Na125 I and chloramine T, whereas human FGF19 retained its affinity for FGFR1-KLB even after iodination. The molecular mechanisms underlying these differences remained elusive. In this study, we first demonstrated that an intramolecular disulfide bond was formed between cysteine-102 and cysteine-121 in FGF21, implying that the oxidation of the cysteine to cysteic acid, which may interfere with the active conformation of FGF21, did not occur during the iodination procedures, and thus ruled out the possibility of the two conserved cysteine residues mediating the loss of FGF21 binding affinity to FGFR1-KLB upon iodination. Site-directed mutagenesis and molecular modeling were further applied to determine the residue(s) responsible for the loss of FGFR1-KLB affinity. The results showed that mutation of a single tyrosine-207, but not the other five tyrosine residues in FGF21, to a phenylalanine retained the FGFR1-KLB affinity of FGF21 even after iodination, whereas replacing the corresponding phenylalanine residue with tyrosine in FGF19 did not alter its binding affinity to FGFR1-KLB, but decreased the receptor binding ability of the iodinated protein, suggesting that tyrosine-207 is the crucial amino acid responsible for the loss of specifying FGFR1-KLB affinity of the iodinated FGF21.

Comparative Efficacy and Safety of Antipsychotic Drugs for Tic Disorders: A Systematic Review and Bayesian Network Meta-Analysis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of antipsychotic drugs for tic disorders (TDs) in a network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, and 4 Chinese databases were searched. Randomized controlled trials (RCTs) evaluating the efficacy of antipsychotic drugs for TDs were included. RESULTS: Sixty RCTs were included. In terms of tic symptom score, compared with placebo, haloperidol, risperidone, aripiprazole, quetiapine, olanzapine, and ziprasidone can significantly improve tic symptom score (standardized mean differences [SMD] ranged from -12.32 to -3.20). Quetiapine was superior to haloperidol, pimozide, risperidone, tiapride, aripiprazole, and penfluridol for improving tic symptom score (SMD ranged from -28.24 to -7.59). Compared with tiapride, aripiprazole could significantly improve tic symptom score (SMD=-4.27). Compared with all other drugs, penfluridol was not effective. Atypical antipsychotics were generally well tolerated. CONCLUSIONS: Atypical antipsychotics (risperidone and aripiprazole) appear to be the most robust evidence-based options for the treatment of TDs. Quetiapine may be a promising therapy. Ziprasidone and olanzapine are also effective, but the evidence is lacking. Further high-quality directly comparing different pharmacological treatment studies are justified.

[Relative Survival of Patients with Ischemic Stroke].

OBJECTIVE: To estimate the relative survival ratio of patients with ischemic stroke and its risk factors. METHODS: Lifetable and Ederer Ⅱ methods were used to estimate the relative survival ratio of patients with ischemic stroke. The Poission error structure model was adopted to determine the risk factors associated with survival. RESULTS: The patients had 99%, 98%, 98% and 99% relative survival ratio 1 year, 3 years, 5 years and 7 years after stroke, respectively. The relative excess risk of death increased with age [53-62 yr. vs. <53 yr., relative excess risk (RER=26.975, 95%CI: 1.668-410.90, P=0.020 1], higher mRS scores (≥3 vs. <3 points, RER=14.700, 95%CI: 1.05-206.45, P=0.047 3), and under body mass (vs. normal body mass, RER=10.082, 95%CI: 2.076-48.958, P=0.004 2). CONCLUSION: Ischemic stroke patients have a good prognosis, with slightly lower survival rates than the matched general populations. Those who are older, under body mass, and have a higher mRS score have lower survival rates.

[Health Utility of Patients with Stroke Measured by EQ-5D and SF-6D].

OBJECTIVE: To compare EQ-5D and SF-6D for measuring health utility of stroke patients in health economic evaluation studies. METHODS: A prospective cohort study was conducted on 596 stroke patients in the West China Hospital of Sichuan University from 2010 to 2016. Data were collected at baseline through face to face interviews and at the follow-up stages through telephone interviews with a three-month interval. EQ-5D and SF-6D were used for measuring health utility scores of the participants. The consistency of the two instruments was assessed using Bland-Altman plot and Intraclass correlation coefficient (ICC) . Logistic regression models were established to identify predictors of health utility. RESULTS: The participants had a mean utility score of 0.78 (95% confidence interval:0.76, 0.80) in EQ-5D,compared with 0.74 (95% confidence interval: 0.73, 0.76) in SF-6D,and a median (interquartile range) of 0.86 (0.68, 1.00) in EQ-5D and 0.73 (0.62, 0.86) in SF-6D. The 95% limits of agreement between the two instruments ranged from -0.28 to 0.35,with an ICC of 0.67 (95% confidence interval: 0.62,0.71). EQ-5D had a higher ceiling effect. The health utility score of stroke patients changed there rapidly in acute phase (less than 3 months) but barely changed there after.Severity of stroke was a major predictor of health utility scores. CONCLUSION: The two instruments generate inconsistent results in health utility. SF-6D is better for measuring health utility in patients with stroke in China.

[Sample Size Calculation using SAS for Phaseâ ¡in Two-stage Clinical Trials of Anti-tumor Drugs].

OBJECTIVE: To compare Gehan two-stage design and Simon two-stage design in sample size calculations for phase Ⅱ clinical trials of anti-tumor drugs. METHODS: We explained the sample size calculation methods with a single-stage design, Gehan two-stage design, and Simon optimal two-stage and minimax two-stage designs in line with the principle of exact binomial probability. By setting up different parameters in SAS macro program, the advantages and disadvantages of these designs were compared. RESULTS: The minimax two-stage design does not increase the maximum sample size compared with the single-stage design. Compared with the Gehan two-stage design, the Simon two-stage design has the advantage of being able to determine an early termination of trials when no or low anti-tumor activities are evident. CONCLUSION: Simon two-stage design is better than single-stage design and Gehan two-stage design. The minimax design is more popular than the optimal design.

[Application of Competing Risks Model in Predicting Smoking Relapse Following Ischemic Stroke].

OBJECTIVE: To determine factors associated with smoking relapse in men who survived from their first stroke. METHODS: Data were collected through face to face interviews with stroke patients in the hospital, and then repeated every three months via telephone over the period from 2010 to 2014. Kaplan-Meier method and competing risk model were adopted to estimate and predict smoking relapse rates. RESULTS: The Kaplan-Meier method estimated a higher relapse rate than the competing risk model. The four-year relapse rate was 43.1% after adjustment of competing risk. Exposure to environmental tobacco smoking outside of home and workplace (such as bars and restaurants) (P=0.01), single (P<0.01), and prior history of smoking at least 20 cigarettes per day (P=0.02) were significant predictors of smoking relapse. CONCLUSION: When competing risks exist, competing risks model should be used in data analyses. Smoking interventions should give priorities to those without a spouse and those with a heavy smoking history. Smoking ban in public settings can reduce smoking relapse in stroke patients.

Assessment of Utilization and Cost-Effectiveness of Telemedicine Program in Western Regions of China: A 12-Year Study of 249 Hospitals Across 112 Cities.

BACKGROUND: The imbalance in healthcare between urban and rural areas is still a problem in China. In recent decades, China has aimed to develop telemedicine. We assessed the implementation, utilization, and cost-effectiveness of a large telemedicine program across western China. MATERIALS AND METHODS: In 2002-2013, a government-sponsored major telemedicine program was established by West China Hospital of Sichuan University (hub), covering 249 spoke hospitals in 112 cities throughout western China and in 40 medical expertise areas. We analyzed the cross-sectional data from 11,987 consultations conducted at West China Hospital using the telemedicine network over a 12-year period. The types of diseases as well as the diagnosis and treatment changes were assessed. We also performed a cost-savings analysis and a one-way sensitivity analysis. RESULTS: Of the 11,987 teleconsultations, we noted that neoplasms (19.4%), injuries (13.9%), and circulatory diseases (10.3%) were the three most common diagnoses. Teleconsultations resulted in a change of diagnosis in 4,772 (39.8%) patients, and 3,707 (77.7%) of them underwent major diagnosis changes. Moreover, it led to a change of treatment in 6,591 (55.0%) patients, including 3,677 (55.8%) changes not linked to diagnosis changes. The telemedicine network resulted in an estimated net saving of $2,364,525 (if the patients traveled to the hub) or $3,759,014 (if the specialists traveled to the spoke hospitals). CONCLUSIONS: The introduction of telemedicine in China, linking highly specialized major hospitals (hub) with hundreds of small rural hospitals (spoke), can greatly improve the quality, efficiency, and cost-effectiveness of healthcare delivery and utilization. This new Internet-based healthcare model should be utilized more widely in developing countries.

[Clinical Trial of Intraoperative Tissue Identification for Breast-Conserving Surgery Using Bio-impedance Spectroscopy].

OBJECTIVE: To evaluate the effectiveness of bio-impedance spectroscopy (BIS) analysis for marginal tissue malignancy/benignancy identification during Breast-Conserving Surgery (BCS). METHODS: A multicenter parallel-group clinical trial was conducted with the patients who received breast conserving surgery in 2 hospitals. One hundred and fifty breast tissue specimens were collected and analyzed by BIS, frozen section biopsy and paraffin section biopsy respectively. Results were compared and statistical analysis was implemented. RESULTS: For BIS technique to identify malignant/benign marginal tissues, the sensitivity was 92.98%, and the specificity was 94.62%. The coherence of BIS results and frozen section biopsy results was significant, and the Kappa value was higher than 0.75. The mean measuring time of BIS was 2.63 min, which was shorter than frozen section biopsy (18.97 min) and paraffin section biospy (1.12 d). CONCLUSION: BIS technique likely has high accuracy in tissue identification so has potential to be adopted as a real-time indicator for marginal tissue malignancy/benignancy identification during breast-conserving surgery.

Aripiprazole for the treatment of tic disorders in children: a systematic review and meta-analysis.

BACKGROUND: Tic disorders (TDs) are common neuropsychiatric disorders in children. Typical antipsychotics, such as haloperidol and pimozide have been prescribed to control tic symptoms as first-line agents. However, adverse effects have led to the use of newer atypical antipsychotics. Aripiprazole is one of alternatives. The aim of this study was to evaluate the efficacy and safety of aripiprazole for children with TDs. METHODS: Randomized controlled trials (RCTs), quasi-RCTs and control studies evaluating aripiprazole for children with tic disorders were identified from PubMed, Embase, Cochrane library, Cochrane Central, four Chinese database and relevant reference lists. Quality assessment referred to the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Twelve studies involving 935 participants were included. The general quality of included studies was poor. Only one study used placebo as a control and others used positive drug controls. Participants were aged between 4 and 18 years. The period of treatment ranged from 8 to 12 weeks. Seven studies (N = 600 patients) used the YGTSS scale as the outcome measurement, and there was no significant difference in reduction of the total YGTSS score between the aripiprazole and positive control groups (MD = -0.48, 95 % CI [-6.22, 5.26], P = 0.87, I(2) = 87 %). Meta-analysis of four of the studies (N = 285 patients) that compared aripiprazole with haloperidol showed that there was no significant difference in reduction of the total YGTSS score (MD = 2.50, 95 % CI [-6.93, 11.92], P = 0.60, I(2) = 88 %). Meta-analysis of two studies (N = 255 patients) that compared aripiprazole with tiapride showed that there was no significant difference in reduction of the total YGTSS score (MD = -3.15, 95 % CI [-11.38, 5.09], P = 0.45, I(2) = 86 %). Adverse events (AEs) were reported in 11 studies. Drowsiness (5.1 %-58.1 %), increased appetite (3.2 %-25.8 %), nausea (2 %-18.8 %) and headache (2 %-16.1 %) were common AEs. CONCLUSION: In conclusion, aripiprazole appears to be a promising therapy for children with TDs. Further well-conducted RCTs are required to confirm this issue.

[Assessing quality of life of patients with stroke using EQ-5D and SF-12].

OBJECTIVE: To compare.the results of EQ-SD and SF-12 for assessing health-related quality of life in stroke patients. METHODS: EQ-5D and SF-12 were administered to 598 ischemic stroke patients through face-to-face interviews. Differences in PCS-12 and MCS-12 scores across different levels of EQ-5D dimensions were tested using analysis of variance (ANOVA). The EQ-5D index and visual analogue scale/score (VAS) scores of respondents were compared between those with higher than and lower than median SF-12 scores using student t-test. Pearson correlations between PCS-12 and EQ-5D scores were tested. RESULTS: PCS-12 and MCA-12 scores varied across different levels of EQ-5D dimensional scores, except for pain/discomfort. EQ-5D and VAS scores varied between those with high and low SF-12 scores. No significant differences in EQ-5D index and VAS scores were found in the EQ-5D indicated healthy respondents between those with high and low SF-12 scores (P>0.05). PCS-12 was positively correlated with EQ-5D index and VAS scores, with r=0.15 (P<0.001) and r=0.33 (P< 0.001), respectively. MCS-12 was also positively correlated with EQ-5D index and VAS score, with r=0.17 (P<0.001) and r = 0.13 (P<0.001), respectively. CONCLUSION: Both instruments are valid measurements for assessing quality of life. The SF-12 appeared to be more sensitive to differences in health status. EQ-5D is preferable if both quality of life assessment and health economics study are to be conducted.

[Determination of the Association Between Smoking and Recurrence of Ischemic Stroke using a Competing Risks Model].

OBJECTIVE: To determine the association between smoking and ischemic stroke recurrence. METHODS: We conducted a prospective follow-up study of patients with first incidence of stroke. A competing risks model was used to establish the association between smoking and stroke recurrence. RESULTS: A total of 594 stroke patients were recruited. Among the 361 male patients, 59 recurrent events and 13 competing events occurred. Among the 233 female patients (all were non-smokers), 49 recurrent events and 11 competing events occurred. Adjusted for confounding factors, male nonsmokers exposed to passive smoking had a SHR of 3. 040 in comparison with those without exposure to smoking and the P value was borderline significant. Those who smoked 100-200 cigarettes a year had a SHR of 0. 947. The other groups with exposure to smoking had a greater than 1 SHR, but without statistical significance. Moreover, no significant associations between recurrence of ischemic stroke and smoking index/cumulative smoking were found. The female nonsmokers who had exposure to passive smoking only at follow-ups had a SHR of 1. 4 (and all other groups had less than 1 SHR). But no statistical significances were found in the comparisons. CONCLUSION: Further research with a larger sample size is needed to establish the association between smoking and recurrence of ischemic stroke.

[Lesion Locations and Quality of Life in Patients with Ischemic Stroke].

OBJECTIVE: To determine the relationship between lesion locations and quality of life (QOL) in patients with ischemic stroke. METHODS: The QOL of 456 stroke survivors was assessed two years after the occurrence of stroke. The EQ-5D was used for measuring QOL. Lesion locations of the patients were identified with CT, MRI and clinical features. Risk factors associated with QOL were identified using a multi-level model. RESULTS: Among the 456 stroke survivors, 61.62% (3/5) had ACI lesions, and more than half of ACI occurred in the subcortex. The number of stroke survivors with left and-right hemisphere lesions was almost equal. Different QOL was found between stroke survivors with a right-side brain lesion and those with non-brain lesions (P<0.001). Significant differences in QOL were also found between those with a subcortex of anterior circulation lesion and others (P<0.044). CONCLUSION: Lesion locations are associated with QOL. Future studies should pay attention to lesion locations classified by vascular territory and brain anatomical structures and size of lesions.

[Changes in health-related quality of life in incipient stroke survivors].

OBJECTIVE: To assess the long-term changes in quality of life of stroke patients. METHODS: A total of 467 stroke survivors were recruited for this study. The participants completed the 12-Item Short Form Health Survey (SF-12) at a three-month interval over two years. Multi-level modelling was performed to identify the trend of changes and associated demographic characteristics. RESULTS: The participants had (31.50 +/- 10.49) PCS and (51.92 +/- 10.03) MCS at the baseline survey. Overall, PCS and MCS scores increased over time, but MCS scores declined slightly 15 months later. Men had higher PCS scores than women. The multi-level model revealed similar trends of PCS changes in those with different gender and education. Older patients had slower changes in quality of life over time (beta9 = -0.013, P = 0.03) compared with their younger counterparts. The trends of MCS changes were similar among those with different age, gender and education. CONCLUSION: Support should be strengthened for female stroke survivors and those with older age and lower levels of education.

[Long term effectiveness of vaccination of Hepatitis A].

OBJECTIVE: To develop a dynamic model of Hepatitis A transmission in order to predict the long-term effectiveness of Hepatitis A vaccination on 18 months old infants and 2 to 18 years old children. METHODS: A dynamic model of HA (S-E-I-R-V) was developed using the software Berkeley-Madonna. The parameters required for the model derived from literature. A sensitivity analysis was performed to assess the stability of the model through changing parameters. RESULTS: During the period of 2010 to 2030, the cumulative cases of Hepatitis A would reach 7.8 million with an incidence of 38.8 per 100,000 without vaccination. With 38% to 57% coverage of vaccination in children of 1.5-18 years old, the cumulative cases would decrease to 4.36-4.75 million with an incidence of 17.5-19.4 per 100,000. The vaccination was predicted to reduce 3.06-3.45 million Hepatitis A cases with an incidence reduction of 19.4-21.3 per 100,000. This suggests that Hepatitis A vaccination would achieve a 54% decrease in incidence of Hepatitis A. The sensitivity analysis showed that the coverage of vaccination had a significant impact on the incidence of Hepatitis A. By 2030, the incidence of Hepatitis A would decrease from 19.4 per 100,000 to 16.0 per 100,000 when the vaccination coverage increases from 38% to 90%. CONCLUSION: Hepatitis A vaccination can effectively prevent and control the incidence of Hepatitis A.

Immune-Related Pneumonitis Was Decreased by Addition of Chemotherapy with PD-1/L1 Inhibitors: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials (RCTs).

PURPOSE: Immune-related pneumonitis (IRP) has attracted extensive attention, owing to its increased mortality rate. Conventional chemotherapy (C) has been considered as an immunosuppressive agent and may thus reduce IRP's risk when used in combination with PD-1/L1 inhibitors. This study aimed to assess the risk of IRP with PD-1/L1 inhibitors plus chemotherapy (I+C) versus PD-1/L1 inhibitors alone (I) in solid cancer treatment. METHOD: Multiple databases were searched for RCTs before January 2021. This NMA was performed among I+C, I, and C to investigate IRP's risk. Subgroup analysis was carried out on the basis of different PD-1/L1 inhibitors and cancer types. RESULTS: Thirty-one RCTs (19,624 patients) were included. The I+C group exhibited a lower risk of IRP in any grade (RR, 0.60; 95% CI, 0.38-0.95) and in grade 3-5 (RR, 0.44; 95% CI, 0.21-0.92) as opposed to the I group. The risk of any grade IRP with PD-1 plus chemotherapy was lower than that with PD-1 monotherapy (RR, 0.50; 95% CI, 0.28-0.89), although grade 3-5 IRP was similar. There was no statistically meaningful difference in the risk of any grade IRP between PD-L1 plus chemotherapy and PD-L1 inhibitors monotherapy (RR, 0.95; 95% CI, 0.43-2.09) or grade 3-5 IRP (RR, 0.71;95% CI, 0.24-2.07). In addition, compared with the I group, the I+C group was correlated with a decreased risk in IRP regardless of cancer type, while a substantial difference was only observed in NSCLC patients for grade 3-5 IRP (RR, 0.39; 95% CI, 0.15-0.98). CONCLUSION: In comparison to PD-1/L1 inhibitor treatment alone, combining chemotherapy with PD-1/L1 inhibitors might reduce the risk of IRP in the general population. Furthermore, PD-1 inhibitors in combination with chemotherapy were correlated with a decreased risk of IRP compared to PD-1 inhibitor treatment alone. In contrast to the I group, the I+C group exhibited a lower risk of IRP, especially for NSCLC patients.

[Responsiveness evaluation of mental intervention services system in Wenchuan earthquake area].

OBJECTIVE: To understand the mental intervention service system responsiveness. METHODS: A stratified, multi-stage random cluster sampling method was used, and a total of 211 residents in the central earthquake area were face to face interviewed by using the evaluating questionnaire of mental intervention service system responsiveness (including confidentiality, autonomy, prompt attention and so on, in sum of eight indicators). Analytic hierarchy process method was used to determine the weight of each index, carrying out a single index evaluation and fuzzy comprehensive evaluation on the mental intervention service system responsiveness, and using Spearman rank correlation and Binary logistic regression model to analyze the relationship of total satisfaction of mental intervention with each index. RESULTS: The dignity and confidentiality indicators were higher weight and rating. Prompt attention and the autonomy indicators were higher weight but lower rating, while surroundings and choice of providers indicators were lower weight and rating. It was also found that communication and social support network indicators were lower weight but higher rating. The overall assessment of mental intervention service system responsiveness ranged between "good" and "very good". All rank correlation coefficients of the indicators and the total satisfaction of mental interventions were significant (r(s) = 0.186 - 0.362, P < 0.05), except for confidentiality. The logistic regression analysis showed that the main factors of the individual variables influencing the total satisfaction were dignity (adjusted OR = 3.047, P < 0.001), surroundings (adjusted OR = 1.619, P = 0.019), and social support network (adjusted OR = 1.527, P = 0.005). CONCLUSION: The overall assessment of mental intervention service system responsiveness was high. Mental interventions should be taken positive and effective measures to improve the prompt attention, autonomy, the choice of providers and service environment.