BackgroundThe combination of immune checkpoint blockade and chemotherapy significantly improves survival when used as first-line treatment for advanced esophageal squamous cell carcinoma. Nonetheless, the safety profiles of various immune checkpoint inhibitor (ICI)-based combination therapies remain inadequately characterized, particularly regarding the incidence of severe adverse events (AEs) and immune-related adverse events (irAEs). The research employed a network meta-analysis to systematically evaluate and contrast the toxicity profiles across various initial ICI-driven treatments for advanced Esophageal squamous cell carcinoma (ESCC).MethodsAn extensive literature review was conducted across PubMed, EMBASE, the Cochrane Library, and Web of Science to identify RCTs evaluating first-line immunotherapy in advanced ESCC. The search included all records from each database’s inception to July 1, 2025. Primary endpoints included grade ≥3 treatment-related adverse events(grade ≥3 trAEs), any-grade irAEs, and grade ≥3 irAEs. Secondary analyses focused on organ-specific irAEs, including immune-mediated rash, hypothyroidism, hyperthyroidism, and pneumonitis. We conducted a Bayesian network meta-analysis to assess relative risks (RRs) and establish a treatment ranking based on Surface Under the Cumulative Ranking Curve (SUCRA) metrics, evaluating the comparative effectiveness of different therapeutic options. The study protocol was prospectively registered with PROSPERO (CRD420251113069).ResultsSeven randomized controlled trials involving 4,479 patients with advanced ESCC were included. In pairwise meta-analyses, ICI plus chemotherapy, compared with chemotherapy alone, increased the risk of grade ≥3 treatment-related adverse events (RR 1.08, 95% CI 1.00-1.17), any-grade irAEs (RR 2.04, 95% CI 1.71-2.44), and grade ≥3 irAEs (RR 2.75, 95% CI 1.98-3.82). Immune-chemotherapy also significantly elevated the risks of immune-mediated rash, hypothyroidism, and hyperthyroidism, whereas the increase in immune-mediated pneumonitis did not reach statistical significance. In Bayesian network meta-analyses, camrelizumab plus chemotherapy had the highest probability of being the regimen with the lowest risk of grade ≥3 trAEs(SCURA = 87.8%) and grade ≥3 irAEs(SCURA = 71.6%), while toripalimab plus chemotherapy ranked safest for any-grade irAEs(SCURA = 83.8%).ConclusionsFirst-line ICI-based regimens for advanced ESCC are associated with an increased risk of severe treatment-related and immune-related toxicities compared with chemotherapy alone, and their safety profiles differ substantially across regimens. Our SUCRA-based rankings provide a comparative overview of regimen-level toxicity that may assist clinicians in understanding relative safety trade-offs when selecting first-line therapy. These findings should be integrated with regimen-specific efficacy data, regulatory indications, PD-L1 status, comorbidities, and patient preferences, and are best interpreted as complementary safety evidence rather than stand-alone treatment recommendations.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD420251113069.

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder in middle‑aged and elderly individuals, with a high recurrence rate that severely impairs quality of life. Cerebral small vessel disease (CSVD) may contribute to BPPV recurrence by impairing vestibular microcirculation, but the correlation between CSVD imaging markers and BPPV recurrence remains unclear. This study aimed to explore their relationship and identify independent risk factors for BPPV recurrence. A retrospective study was conducted including 131 middle‑aged and elderly patients with newly diagnosed BPPV from December 2024 to October 2025. All patients underwent diagnosis and repositioning treatment using the SRM‑IV system and were followed for 4 months. Cranial 3.0T MRI was performed to evaluate CSVD imaging markers according to the 2023 STRIVE‑2 criteria. Clinical and imaging data were compared between recurrence and non‑recurrence groups. Statistical analyses were performed using SPSS 26.0, including t‑test, Mann‑Whitney U test, χ² test, and binary logistic regression. The 4‑month recurrence rate was 29.0

Background:Subcutaneous (SC) trastuzumab offers a more convenient alternative to intravenous (IV) administration for HER2-positive breast cancer, potentially improving healthcare efficiency and patient experience. Although SC trastuzumab was approved in Europe in 2013 and in the United States in 2019, it only became available in China in 2022, highlighting the need to synthesize global evidence for regions where SC adoption is recent. Methods:A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library through 20 March 2025, identified studies comparing SC and IV trastuzumab. Meta-analyses were performed using random- or fixed-effects models to evaluate pathological complete response (pCR), event-free survival (EFS), adverse events, serious adverse events, and patient preference. A cost-minimization analysis (CMA) was additionally performed from the perspective of the Chinese healthcare system. Results:Nine studies were included. SC trastuzumab demonstrated comparable pCR (OR = 1.11, 95% CI: 0.86-1.42) and EFS (HR = 0.96, 95% CI: 0.78-1.19) to IV administration. SC was associated with a higher incidence of mild-to-moderate local reactions (OR = 1.59, 95% CI: 1.38-1.84) but no significant difference in serious adverse events (OR = 1.37, 95% CI: 0.94-1.99). Patient preference strongly favored SC (OR = 63.02, 95% CI: 34.43-115.34). Cost-minimization analysis showed that 18 cycles of SC trastuzumab (100,597 CNY) reduced costs by approximately 7% compared with the IV originator (108,032 CNY) and were generally comparable to domestic biosimilars, which ranged from 79,432 to 101,817 CNY. Conclusion:SC trastuzumab demonstrates comparable clinical outcomes to IV administration, with a marked patient preference advantage and potential cost savings compared with the IV originator and domestic biosimilars. These findings are particularly relevant to healthcare systems where SC formulations are newly introduced, providing timely evidence to guide patient-centered clinical decision-making. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=637674, identifier CRD42025637674.

Objective: To explore the prognostic value of systemic immune-inflammation in assessing patients with non-small cell lung cancer. Method: The meta-analysis was conducted from May to July 2023, and comprised a comprehensive search PubMed, Excerpta Medica Database and Cochrane Library databases up to March 21, 2023, for relevant peer-reviewed articles evaluating the prognostic value of systemic immune-inflammation in patients with non-small cell lung cancer. Hazard ratio and 95% confidence interval were calculated to assess systemic immune-inflammation’s relationship with overall survival and progression-free survival. Data was analysed using STATA 17.0. Results: Of the 135 studies initially identified, 32(23.7%) were analysed in detail, involving 12,040 patients. Increased systemic immune-inflammation was significantly associated with poor overall survival (hazard ratio: 1.31; 95% confidence interval: 1.21-1.41; p<0.001) and progression-free survival (hazard ratio: 1.48; 95% confidence interval: 1.12-1.94; p<0.001) in non-small cell lung cancer patients. Subgroup analysis confirmed these findings, with significant associations observed across various subgroups (country, sample size, cut-off value, survival analysis type, and TNM stage). Sensitivity analysis showed that the pooled hazard ratios remained stable, with no significant changes upon the exclusion of individual studies (p=0.75 for OS and p=0.83 for PFS). Publication bias was assessed and no significant bias was observed for either OS or PFS (Egger's test p=0.12 for OS and p=0.18 for PFS). Conclusions: High systemic immune-inflammation was found to be a significant predictor of poor overall survival and progression-free survival in non-small cell lung cancer patients. Key Words: Systemic immune-inflammation index, Non-small cell lung cancer, Meta-analysis, Prognosis.

BACKGROUND AND OBJECTIVES:A variety of observational studies suggest a possible connection between C-X-C Motif Chemokine Ligand 5 (CXCL5) and vascular dementia (VaD), though the exact causal relationship is still uncertain. This research aims to investigate the causal connection between CXCL5 and VaD risk through a Mendelian randomization (MR) method and to examine the phosphate-to-glucose ratio as a possible mediator. METHODS:Using summary-level data from genome-wide association studies (GWAS), we conducted a two-sample MR analysis to investigate the genetic prediction of CXCL5 and VaD. Horizontal pleiotropy, heterogeneity, and sensitivity analyses were also performed on the MR findings. Additionally, a two-step MR was utilized to quantify the proportion of the effect of CXCL5 on VaD mediated by the phosphate-to-glucose ratio. RESULTS:MR analysis identified that higher levels of CXCL5 (IVW: p = 0.022, OR = 1.265, 95% CI = 1.034-1.547) increase the risk of VaD. Tests for horizontal pleiotropy (p > 0.05), heterogeneity (p > 0.05), and sensitivity analyses supported these findings. There is insufficient robust evidence to suggest that genetic predispositions for VaD have any significant impact on CXCL5 (IVW: p = 0.254). The phosphate-to-glucose ratio accounted for 11.1% of increase in the risk of VaD associated with CXCL5 (95% CI = -12.3% to 34.5%). CONCLUSION:To conclude, our research confirms a causal link between CXCL5 and VaD and shows that the ratio of phosphate-to-glucose plays a mediating role in a segment of the risk effect of CXCL5 on VaD. However, most of the effects of CXCL5 on VaD are still not well understood. Additional studies are necessary to explore other potential mediators as risk factors. In clinical settings, individuals with abnormally elevated CXCL5 may need to be monitored for an increased risk of developing VaD.

IntroductionThis study systematically reviewed and conducted a network meta-analysis to assess the efficacy and safety of first-line and second-line immunotherapy treatments for recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). The findings aim to provide robust evidence to guide clinical decision-making.MethodsWe conducted an comprehensive literature search in PubMed, Embase, Cochrane Library, and Web of Science. The outcome measures included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and grade 3 or higher adverse events (AEs ≥3). To compare the efficacy and safety of various first-line and second-line immunotherapy regimens for R/M HNSCC with different PD-L1 expression levels, we conducted a Bayesian network meta-analysis. This study is registered in the Prospective Register of Systematic Reviews (CRD42024551711).ResultsThis analysis included 9 randomized controlled trials (RCTs) involving 5,946 patients and seven immunotherapy regimens. Among patients with R/M HNSCC, pembrolizumab combined with chemotherapy as a first-line treatment was the only immunotherapy regimen to show a PFS benefit compared to SOC (HR = 0.92, 95% CI: 0.77–1.10); however, the difference was not statistically significant. Meanwhile, nivolumab provided the most pronounced OS benefit (HR=0.71,95%CI:0.52-0.98). Additionally, pembrolizumab exhibited the most favorable safety profile relative to SOC (OR=0.12, 95% CI: 0.05-0.29). In second-line therapy, nivolumab outperformed SOC in multiple aspects, including OS (HR=0.68, 95% CI: 0.54-0.86), ORR (OR=0.40, 95% CI: 0.17-0.95), and grade ≥3 adverse events (OR=0.32, 95% CI: 0.19-0.54). Subgroup analysis by PD-L1 expression revealed that nivolumab, compared to SOC, conferred the greatest OS benefit (HR=0.59, 95% CI: 0.34-1.00) as a first-line therapy in patients with PD-L1 expression ≥1%, while pembrolizumab combined with chemotherapy(pem-chemo) showed the most substantial PFS benefit (HR=0.82, 95% CI: 0.67-1.00). For patients with PD-L1 expression ≥20%, pem-chemo delivered the optimal OS (HR=0.60, 95% CI: 0.44-0.81) and PFS (HR=0.73, 95% CI: 0.55-0.97) outcomes compared to SOC. Furthermore, in patients with PD-L1 expression ≥1%, nivolumab as a second-line treatment demonstrated superior OS (HR=0.55, 95% CI: 0.39-0.78) and PFS (HR=0.59, 95% CI: 0.41-0.84) compared to SOC.ConclusionsThese results suggest that immunotherapy may improve survival outcomes compared to SOC for patients with R/M HNSCC, while maintaining a comparable safety profile. For patients, pembrolizumab combined with chemotherapy and nivolumab as first-line treatments may represent the most optimal options, with nivolumab also showing promise as a second-line therapy. In patients with PD-L1 expression ≥1% or ≥20%, pembrolizumab combined with chemotherapy may be the preferred first-line therapy, while nivolumab remains the most favorable second-line treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024551711.

Background A multitude of randomized controlled trials (RCTs) conducted in both the initial and subsequent treatment settings for patients diagnosed with metastatic colorectal cancer (mCRC) have provided clinical evidence supporting the efficacy of immunotherapy with the use of immune checkpoint inhibitors (ICIs). In light of these findings, the U.S. Food and Drug Administration (FDA) has authorized the use of several ICIs in specific subpopulations of mCRC patients. Nevertheless, there remains a dearth of direct comparative RCTs evaluating various treatment options. Consequently, the most effective ICI therapeutic strategy for microsatellite-stable (MSS) subgroup and microsatellite instability (MSI) subgroup in the first- and second-line therapies remains undefined. To address this gap, the present study employs a Bayesian network meta-analysis to ascertain the most effective first- and second-line ICI therapeutic strategies. Methods A comprehensive literature search was conducted across multiple databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, with the retrieval date ranging from the databases' inception to August 20, 2024. A total of 875 studies were identified, and seven were ultimately included in the analysis after a screening process. A systematic review and network meta-analysis were conducted on the basis of the search results. Results This comprehensive analysis, comprising seven RCTs, evaluated first-line and second-line immunotherapy regimens in 1,358 patients diagnosed with mCRC. The treatments under investigation consisted of five initial treatments, including three focusing on MSS patients and two on MSI patients, as well as two secondary immunotherapy regimens, both focusing on MSS patients. A total of 1051 individuals underwent first-line treatment, while 307 received second-line treatment. The application of ICIs proved to offer varying degrees clinical benefits when compared to standard-of-care therapy alone, both in two subgroups of the first and the second treatment phases. Of particular note is the performance of Nivolumab combination with ipilimumab, which demonstrated superior efficacy in improving progression-free survival (PFS) (HR=0.21; 95% CI, 0.13-0.34),. Moreover, the treatment demonstrated an optimal safety profile, with a relatively low risk of adverse events (OR = 0.33; 95% CI, 0.19-0.56), compared to other first-line treatment modalities for MSI subgroup. Regarding MSS subgroup, the improvement of PFS by Nivolumab plus standard-of-care (SOC) was relatively significant (HR = 0.74; 95% CI, 0.53-1.02). In the realm of second-line therapies for MSS subgroup, the administration of Atezolizumab plus SOC has proven to be an effective approach for prolonging PFS, exhibiting an HR of 0.66 (95% CI, 0.44-0.99). These findings underscore the clinical benefits and safety profiles of ICIs in the treatment of mCRC across various treatment lines. Conclusions The clinical application of ICIs in both first- and second-line treatment strategies for patients with mCRC yields substantial therapeutic benefits. A detailed assessment in this study indicates that first-line treatment with Nivolumab combination with ipilimumab may represent an efficacious and well-tolerated therapeutic approach for MSI subgroup. In terms of MSS subgroup in first-line therapy, Nivolumab plus SOC may be a relative superior choice. In the context of second-line therapy for MSS subgroup, it is evident that a combination of Atezolizumab and SOC represents a preferable option for enhancing PFS. Furthermore, it is noteworthy that other ICIs treatment regimens also exhibit great value in various aspects, with the potential to inform the development of future clinical treatment guidelines and provide a stronger rationale for the selection of ICIs in both first- and second-line therapeutic strategies for mCRC. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42024543400.

The use of immune checkpoint inhibitors has led to an increase in randomized controlled trials exploring various first-line combination treatment regimens. With the introduction of new PD-1/PD-L1 inhibitors, there are now more clinical options available. For the first time, the AK105 monoclonal antibody Penpulimab, developed in China, was included. The AK105-302 Phase III trial studied the efficacy and safety of Penpulimab combined with chemotherapy in patients with advanced or metastatic squamous NSCLC. To determine the optimal treatment options, we conducted an updated network meta-analysis to compare the effectiveness and safety of these regimens. The system retrieves data from Chinese and English electronic databases, Clinical Trials, and the gov Clinical Trial Registration website up to September 6, 2023. The study indirectly compared the efficacy and safety of PD-1/PD-L1 combination regimens, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), all-grade adverse events, and above-grade III adverse events. Subgroup analyses were conducted based on programmed death ligand 1 (PD-L1) level, histological type, ECOG score, sex, and smoking history. Nineteen RCTS were included, with a total of ten thousand eight hundred patients. Penpulimab plus chemotherapy (Pen + CT) provided the best OS (HR = 0.55, 95

BackgroundRandomized controlled trials (RCTs) have unequivocally established the therapeutic advantages of combining immune checkpoint inhibitors (ICIs) with chemotherapy in the treatment of early-stage non-small cell lung cancer (NSCLC). Presently, numerous perioperative immunotherapy regimens centered around the integration of ICIs and chemotherapy have undergone clinical trials. Nonetheless, due to the absence of direct comparative RCTs among these treatment regimens, this study aims to employ Bayesian network meta-analysis to ascertain the optimal combination of ICIs and chemotherapy.MethodsA systematic literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science databases, and major international conference publications up to April 10, 2024. This comprehensive search yielded a total of 1434 studies. Following a rigorous screening process that involved evaluating the studies for relevance, methodological quality, and alignment with our research objectives, 8 studies were carefully selected for inclusion in the final analysis. Based on these curated search results, a systematic review and network meta-analysis were conducted.Results8 RCTs were included, encompassing 7 treatments and involving 3699 operable NSCLC patients at stages I-III. Compared to chemotherapy alone, perioperative immunotherapy demonstrated higher efficacy. The combination of toripalimab and chemotherapy showed the most significant improvement in event-free survival (EFS) (HR= 0.40; 95% CI, 0.28-0.58). The regimen that most notably enhanced overall survival (OS) was Nivolumab combined with chemotherapy (HR = 0.62; 95% CI, 0.36-1.07). In terms of pathological complete response (pCR), the combination of Toripalimab and chemotherapy exhibited the highest benefit (OR = 32.89; 95% CI, 7.88-137.32). Regarding the improvement in R0 resection, Pembrolizumab plus chemotherapy performed most prominently(OR=2.15; 95% CI, 1.30-3.56). In terms of the incidence of grade 3 or higher adverse events, durvalumab combined with chemotherapy had the lowest incidence (OR = 1.05; 95% CI, 0.79-1.38), while the incidence for other regimens was higher than chemotherapy alone.ConclusionThe efficacy of perioperative immunotherapy plus chemotherapy in patients with early NSCLC is significantly improved compared to chemotherapy alone. Although there is a certain risk of adverse events, the safety is within a controllable range. After a comprehensive evaluation of five endpoints in this study, it is believed that the combination of Toripalimab or Nivolumab with chemotherapy may be the optimal immunotherapy regimen for the treatment of stage Ib-IIIb NSCLC. These findings will help guide the design of clinical treatment plans and ICIs selection.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42024536799.

ObjectiveThe optimal first-line immunotherapy regimen for patients with PD-L1 expression ≥50% in squamous non-small cell lung cancer (Sq-NSCLC) remains uncertain. This study utilized net-work meta-analysis (NMA) to indirectly compare the efficacy of various first-line immuno-therapy regimens in this patient subset.MethodsSystematic searches were conducted across PubMed, the Cochrane Library, Web of Science, and Embase databases for randomized controlled trials reporting overall survival (OS) and progression-free survival (PFS) outcomes. The search spanned from database inception to November 3, 2023. Bayesian network meta-analysis was employed for a comprehen-sive analysis. To ensure scientific rigor and transparency, this study is registered in the Interna-tional Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42022349712.ResultsThe NMA encompassed 9 randomized controlled trials (RCTs), involving 2170 patients and investigating 9 distinct immunotherapy regimens. For OS, the combination of camrelizumab and chemotherapy demonstrated the highest probability (36.68%) of efficacy, fol-lowed by cemiplimab (33.86%) and atezolizumab plus chemotherapy (23.87%). Regarding PFS, the camrelizumab and chemotherapy combination had the highest probability (39.70%) of efficacy, followed by pembrolizumab (22.88%) and pembrolizumab plus chemotherapy (17.69%). Compared to chemotherapy, first-line treatment with immune checkpoint inhibitors (ICIs) in Sq-NSCLC pa-tients exhibited significant improvements in OS (HR 0.59, 95% CI 0.47-0.75) and PFS (HR 0.44, 95% CI 0.37-0.52).ConclusionThis study suggests that, for Sq-NSCLC patients with PD-L1 expression ≥50%, the first-line immunotherapy regimen of camrelizumab plus chemotherapy provides superior OS and PFS outcomes. Furthermore, ICIs demonstrate enhanced efficacy compared to chemotherapy in this patient population.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD 42022349712.

OBJECTIVE:Previous studies have shown that immune checkpoint inhibitors can improve the survival of patients with advanced non-small cell lung cancer with KRAS mutations; however, there is a lack of comparisons between treatment regimens associated with immune checkpoint inhibitors, and our study aims to compare several treatment parties to find a more effective treatment regimen.METHOD:A comprehensive literature search was conducted across multiple databases, namely PubMed, Web of Science, Embase, and Cochrane Library, to identify relevant studies. The screened studies were thoroughly examined, and data were collected to establish a Bayesian framework. The study focused on two primary endpoints: overall survival (OS) and progression-free survival (PFS). Data analysis and graphical plotting using R software and Revman (version 5.3). It is worth mentioning that the study protocol was registered with the International Prospective Registry for Systematic Reviews, ensuring transparency and adherence to predetermined protocols (CRD42022379595).RESULT:In total, our analysis included six RCTs involving 469 patients with KRAS mutations. Among these patients, 224 received chemotherapy, while 245 were treated with immune checkpoint inhibitors. Meta-analysis results showed that the addition of ICIs could significantly improve OS and PFS (0.69, 95% CI 0.55, 0.86; 0.57, 95% CI 0.42, 0.77). The results of the network meta-analysis showed that Pembrolizumab could improve OS (HR 0.42, 95% CI 0.22-0.80) and Pembrolizumab emerged as the most effective treatment option for enhancing OS in patients (SUCRA 65.03%). Additionally, pembrolizumab in combination with chemotherapy showed improvement in PFS (HR 0.47, 95% CI 0.29-0.76).CONCLUSION:Our analysis found that among advanced NSCLC patients with KRAS gene mutations, first-line treatment with pembrolizumab alone demonstrated greater efficacy. Similarly, second-line treatment with nivolumab alone was found to be more effective in this patient population. However, the sample size of this study was limited, Therefore, additional clinical data is necessary to validate this finding in subsequent research.

Abstract Objective Patients with KRAS-mutated NSCLC will have a lower survival rate than patients with KRAS gene wild-type, for whom the use of immune checkpoint inhibitors has a significant benefit. We conducted a systematic evaluation and network meta-analysis to find the best treatment option for such patients with ICIs by comparing the efficacy of immune checkpoint inhibitors (PD-1/PD-L1 inhibitors as well as CALT-4 inhibitors) in patients with advanced or metastatic NSCLC with KRAS mutations.Method Until October 30, 2022, a systematic searched of Pubmed, Embase, Cochrane library and Web of Science. The primary endpoint were overall survival (OS) and progression-free survival (PFS) of KRAS-mutated patients treated with immune checkpoint inhibitors compare with chemotherapy. All statistical were made with R-studio.Result Overall, 6 studies that included a total 469 patients were analyzed in this meta-analysis. Pembrolizumab monotherapy had a higher OS than chemotherapy (HR 0.42, 95% CI 0.22, 0.8) and pembrolizumab combined with chemotherapy had a higher PFS than chemotherapy (HR 0.47 95% CI 0.29,0.76). In terms of OS, among NSCLC patients with KRAS-mutated, pembrolizumab monotherapy was the best treatment for their first-line treatment and nivolumab was the best treatment for second-line treatment. In contrast, atezolizumab monotherapy had no significant advantage in this group. Of the five non-chemotherapy regimens, pembrolizumab was not as effective in combination with chemotherapy, but the benefit of this regimen was greater than pembrolizumab monotherapy and nivolumab monotherapy in terms of PFS.Conclusion In terms of efficacy, the best immunotherapy regimen for patients with KRAS-mutated NSCLC is the use of pembrolizumab monotherapy, which is also the best treatment for first-line therapy in this group, followed by the recommendation of nivolumab monotherapy, which is also the best treatment for second-line therapy in this group.

Introduction The optimal first-line immunotherapy regimen for advanced non-squamous non-small cell lung cancer (NS-NSCLC) patients with programmed cell death ligand 1 (PD-L1) expression ≥ 50% remains unclear. Our aim is to determine the most effective treatment regimen through a network meta-analysis (NMA) comparing these treatments. Methods A systematic search was performed in PubMed, Cochrane Library, Web of Science, and Embase databases, and a Bayesian network meta-analysis was conducted. To ensure transparency, the study was registered in the International Prospective Register of Systematic Reviews (CRD42022349712). Results The analysis included 11 randomized controlled trials (RCTs) with 2037 patients and 12 immunotherapy combinations. ICI-ICI, ICI alone, and chemotherapy-ICI showed significant advantages over chemotherapy in terms of overall survival (OS) and progression-free survival (PFS). Pembrolizumab plus chemotherapy showed the best OS results compared to chemotherapy. Tislelizumab plus chemotherapy and sintilimab plus chemotherapy provided the best PFS results. Conclusions For NS-NSCLC patients with PD-L1 ≥ 50%, pembrolizumab plus chemotherapy, tislelizumab plus chemotherapy, and sintilimab plus chemotherapy are recommended as good treatment options based on the results of this Network meta-analysis (NMA).

Introduction: Since December 2019, coronavirus 2019 (COVID-19) has rapidly spread to become a global pandemic, exerting a great pressure on medical staff worldwide. This study aimed to observe whether COVID-19 influenced the diagnosis and treatment of ischemic stroke (IS). Material and methods: This study retrospectively analysed the clinical data (number of emergencies, time from onset to treatment, and door-to-needle time [DNT]) of patients with acute IS (AIS) treated in our hospital within six months of the first case of COVID-19 reported in the city; the derived data were then compared with the situation of patients during the same period in 2019. Results: The results showed that the number of medical visits during the period of COVID-19 decreased by 44.3%, and the median time from the onset of IS to emergency treatment was 35 min longer than that during the same period in 2019. The median time from entering the emergency department to the completion of cranial computerized tomography was 8 min shorter than during the same period in 2019, and the median time of DNT was relatively shorter than that during the same period in 2019. Conclusions: The pandemic situation of COVID-19 significantly reduced the number of patients with AIS and prolonged the travel time to the hospital whereas most of the stroke treatment services were maintained.

Background:Cerebral revascularization is a neurosurgical procedure used to restore the cerebral collateral circulation channel. This study examines the countries, institutions, authors, journals, keywords, and references related to the disease in the field of cerebral revascularization from 1999 to 2022 from a bibliometrics perspective, evaluates the changes of knowledge structure clustering and identifies the new hot spots and new research directions in this field.Methods:The Web of Science Core Collection (WOSCC) database and the PICOS retrieval method were used to conduct a comprehensive search for articles and reviews pertaining to cerebral revascularization. The final filtered data were bibliometrically and visually drawn using Microsoft office 365, CiteSpace (v.6.1.R2), and VOSviewer (v.1.6.18).Results:From 1999 to 2022, a total of 854 articles pertaining to cerebral revascularization, which originated from 46 nations, 482 institutions, and 686 researchers, were extracted from the WOSCC database, and the number of publications in this field of study was rising. The United States held the highest proportion in the ranking analysis of countries, institutions, authors, and journals. By analyzing co-citations, the scientific organization of this field and the development status of frontier fields were realized. Cerebral revascularization, moyamoya disease, extracranial intracranial bypass, and occlusion are the current research focal points in the field of cerebral revascularization. Hyperperfusion and vascular disorder may also become a new study focus in this discipline in the near future.Conclusion:Using the method of bibliometrics, this study analyzed and reviewed the articles in the field of cerebral revascularization, which enabled scholars to better comprehend the dynamic process in this field and provided a foundation for future in-depth research.

In recent years, immunotherapy has become a major research focus in the field of cancer treatment. Because of its good efficacy and lasting immune response, immune checkpoint inhibitors have benefited the long-term survival of many types of cancer patients. However, overactivation of the immune system may attack normal organs and cause a series of immune related adverse reactions. Among them, due to the high incidence of immune-related colitis, it deserves special attention. Camrelizumab is a programmed cell death 1 (PD-1) inhibitor that was developed by Jiangsu Hengrui Medicine Company. We reported the clinical data of a case of hepatocellular carcinoma with immune-related colitis after treatment with camrelizumab. A 63-year-old man with hepatocellular carcinoma developed diarrhea and hematochezia after receiving 4 cycles of camrelizumab. Endoscopy showed multiple flake congestion and edema in the terminal ileum and total colon mucosa with bright red surface. Pathological evaluation showed chronic inflammation of colonic mucosa. After giving 0.25g bid of enteric-coated sulfasalazine tablets orally for 6 weeks, his colitis improved. Camrelizumab can induce immune-related colitis. Sulfasalazine could be used to reduce adverse reactions of glucocorticoids.

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients' transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05), angiography success rate (97.3% vs. 95.1%, P > 0.05), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05), puncture time (22.42 vs. 31.02 min, P < 0.05), and complications (3.57% vs. 9.03%, P < 0.05) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group (P < 0.05). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Background: Convolutional neural networks (CNNs) have demonstrated expertlevel performance in cutaneous tumour classification using clinical images, but most previous studies have focused on dermatologist-versus-CNN comparisons rather than their combination. The objective of our study was to evaluate the potential impact of CNN assistance on dermatologists for clinical image interpretation.Methods: A multi-class CNN was trained and validated using a dataset of 25,773 clinical images comprising 10 categories of cutaneous tumours. The CNN's performance was tested on an independent dataset of 2107 images. A total of 400 images (40 per category) were randomly selected from the test dataset. A fully crossed, self-control, multi-reader multi-case (MRMC) study was conducted to compare the performance of 18 board-certified dermatologists

Importance. Following the research, we discovered that other meta-analyses contained incomplete genes or did not include a sufficient number of trials. To address these limitations, this meta-analysis sought to find studies examining the extent toward epidermal growth factor receptor (EGFR) or KRAS or mutation status gives data on both the probability of a specific illness outcome very independent of treatment (prognostic factor) and possibility of advantage from a particular therapy (predictive factor) in non-small-cell lung cancer (NSCLC) patients. Objective. To assess and compare the effectiveness of immune checkpoint inhibitors vs. chemotherapy for KRAS-mutant or EGFR-mutant non-small-cell lung cancers. Methods. Until February 19, 2022, Cochrane Library, PubMed, Web of Science, and Embase were searched for relevant randomized controlled trials (RCTs) in NSCLC. Progression-free survival (PFS) and overall survival (OS) were used as outcome measures. The studies were conducted using the Cochrane methodology for meta-analyses, and all statistical analyses were made with Review Manager Software (RevMan version 5.4). Results. Our meta-analysis included nine clinical trials including 5633 participants with NSCLC. Immune checkpoint drugs extended OS (hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.60–0.76) and PFS (HR, 0.44; 95% CI, 0.35-0.56) in patients with EGFR wild-type compared to chemotherapy alone, whereas programmed cell death 1 ligand 1 (PD-L1)/programmed cell death-1 (PD-1) inhibitors with chemotherapy versus chemotherapy extended PFS in NSCLC patients with EGFR mutations (HR, 0.63; 95% CI, 0.42-0.94). Meanwhile, immune checkpoint inhibitors vs. chemotherapy improved the OS (HR, 0.65; 95% CI, 0.48–0.88) and PFS (HR, 0.49; 95% CI, 0.36–0.66) of NSCLC patients with KRAS mutation. NSCLCs with KRAS G12C mutation had a much better PFS with ICIs than with chemotherapy (HR, 0.38; 95% CI, 0.21–0.71). Conclusion. This research revealed that individuals with EGFR wild-type NSCLC or KRAS mutation may benefit from PD-L1/PD-1 inhibitors and that PD-L1/PD-1 inhibitors in combination with chemotherapy seem to be more successful than chemotherapy alone in NSCLC patients with EGFR mutation.