Heterogeneity of lymphocyte subsets in predicting immune checkpoint inhibitor treatment response in advanced lung cancer: an analysis across different pathological types, therapeutic drugs, and age groups.

Background: Immune checkpoint inhibitor (ICI) has become pivotal in the treatment of advanced lung cancer, yet the absence of reliable biomarkers for assessing treatment response poses a significant challenge. This study aims to explore the predictive value of various lymphocyte subsets in different lung cancer subtypes, thus potentially identifying novel biomarkers to improve ICI treatment stratification and outcomes. Methods: We conducted a retrospective analysis of 146 stage III or IV lung cancer patients undergoing ICI treatment. The study focused on exploring the relationship between various lymphocyte subsets and the efficacy of ICIs, aiming to determine their predictive value for post-treatment outcomes. Results: Subgroup analysis revealed a positive correlation (P=0.01) between lower CD3+CD8+ T lymphocyte levels and treatment response in squamous cell carcinoma patients. However, no significance was observed in lung adenocarcinoma patients. Additionally, the predictive ability of lymphocyte subsets for different immunotherapy drugs varies. In individuals receiving anti-programmed cell death ligand 1 (PD-L1) treatment, a lower CD3+CD8+ T lymphocyte levels is significantly associated with a positive treatment outcome (P=0.002), while there is no difference for programmed death 1 (PD-1) drugs. Among patients under 60, higher expression of CD3+CD4+ T lymphocytes (P=0.03) combined with lower CD3+CD8+ T lymphocyte levels (P=0.006) showed a statistically significant association with improved treatment response. However, in patients aged over 60, no discernible correlation was ascertained between lymphocyte subsets and therapeutic response. Through prognostic analysis, two distinct lymphocyte subsets were identified, both exerting considerable impact on progression-free survival subsequent to ICIs treatment: CD3+CD4+ T lymphocytes [hazard ratio (HR) =0.50, P=0.006] and CD3+CD8+ T lymphocytes (HR =1.78, P=0.02). Conclusions: Our findings underscore the significant heterogeneity in the predictive value of distinct lymphocyte subsets for lung cancer patients undergoing ICI treatment. These findings are particularly salient when considering various pathological types, immunotherapeutic agents, and patient age groups.

The prognostic value of 11th Japanese classification and 8th AJCC staging systems in Chinese patients with esophageal squamous cell carcinoma.

BACKGROUND: Two staging systems, the 8th staging system by the American Joint Committee on Cancer (AJCC) and the 11th Japanese classification by Japan Esophageal Society (JES), are currently applied in the clinic for predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC). The differences between the two staging systems have been widely researched. However, little studies focus on the differences in specific staging between the two systems. Therefore, we aimed to compare the performance of different staging in predicting overall survival (OS) of Chinese patients with ESCC. METHODS: This retrospective study included 268 patients who underwent radical esophagectomy and mediastinal lymph node dissection for ESCC between January 2008 and December 2013. Patients were staged by the 8th AJCC and 11th JES staging systems. OS was estimated using the Kaplan-Meier method and compared between N stages and between stage groupings using the log-rank test. Cox proportional hazards regression analysis was performed to identify factors independently related to outcome. Further, we compared the concordance indexes (C-indexes) of the two staging systems. RESULTS: The mean age was 61.25 ± 7.056 years, median follow-up was 44.82 months, and 5-year OS rate was 47%. The OS was well predicted by the 8th AJCC N staging (P < 0.001) and the 11th JES N staging (P < 0.001), with a c-index of 0.638 (95% CI: 0.592-0.683) for AJCC N staging and 0.627 (95% CI: 0.583-0.670) for JES N staging (P = 0.13). In addition, the OS was also well predicted by stage groupings of the 8th AJCC (P < 0.001) and the 11th JES systems (P < 0.001), with a c-index of 0.658 (95% CI: 0.616-0.699) for 8th AJCC stage grouping and 0.629 (95% CI: 0.589-0.668) for the11th JES stage grouping (P = 0.211). CONCLUSIONS: The prognostic effect of 11th JES staging system is comparable with that of AJCC 8th staging system for patients with ESCC. Therefore, both systems are applicable to clinical practice.

Intrinsic drive of medical staff: a survey of employee representatives from 22 hospitals in China.

Objective: While several initiatives, including monetary rewards and performance system reform, are used to inspire medical staff, none are fully effective. We sought to describe the intrinsic drive of medical staff and identify elements that improve work enthusiasm by increasing internal motivation. Methods: A cross-sectional study was conducted in which 2,975 employee representatives from 22 municipal hospitals in Beijing, China were interviewed using a self-made intrinsic motivation scale for medical staff which includes the achievement motivation, self-efficacy, conscientiousness, gratitude level and perceived organizational support. The Kruskal-Wallis analysis of variance and multiple linear regression methods were used to investigate the level of intrinsic motivation and identify any influencing factors. The correlation between employee drive and turnover intention was determined using Spearman rank correlation analysis and Kendall's tau b rank correlation coefficient. Results: A total of 2,293 valid answers were obtained, with a valid recovery rate of 77.1%. There were statistically significant differences in intrinsic motivation and its five dimensions by marital status, political status, profession, service year, monthly income, number of working hours per week, and turnover intention (p < 0.05). Being divorced, a CPC member, in the nursing profession, and having a higher monthly income had a positive impact on intrinsic motivation while working a high hours per week had a negative effect. Higher work drive was associated with lower turnover intention. The correlation coefficients of intrinsic drive and its five dimensions with turnover intention ranged from 0.265 to 0.522 (p < 0.001). Conclusion: Sociodemographic factors and work environment influenced the intrinsic motivation of medical staff. There was a correlation between work drive and turnover intention which indicated that stimulating the intrinsic drive of employees may help to increase staff retention.

Safety and efficacy of pegylated recombinant human granulocyte colony-stimulating factor during concurrent chemoradiotherapy for small-cell lung cancer: a retrospective, cohort-controlled trial.

OBJECTIVE: To investigate pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) safety and efficacy in preventing hematological toxicity during concurrent chemoradiotherapy (CCRT) for small-cell lung cancer (SCLC). METHODS: We retrospectively assessed 80 SCLC patients treated with CCRT from January 2013 to December 2018 who received PEG-rhG-CSF within 48 hours after the end of chemotherapy, defined as prophylactic use, as the experimental group. An additional 80 patients who were not treated with PEG-rhG-CSF were matched 1:1 by the propensity score matching method and served as the control group. The main observations were differences in hematological toxicity, neutrophil changes, febrile neutropenia (FN) incidence and adverse reactions. Progression-free survival (PFS) and overall survival (OS) were analyzed with regular assessment and follow-up. RESULTS: The leukocyte, neutrophil, erythrocyte, and platelet counts and hemoglobin level decreased after CCRT, but the experimental group had slightly higher leukocyte and neutrophil counts than the control group (P < 0.05). The incidences of grade III-IV leukopenia (18.75% vs. 61.25%) and neutropenia (23.75% vs. 67.5%) in the experimental group were significantly lower than those in the control group (P < 0.05). The absolute neutrophil count was 4.17 ± 0.79 (× 109/L) on day 1 and peaked 6.81 ± 2.37 (× 109/L) on day 10 in the experimental group; the value in the control group was 2.81 ± 0.86 (× 109/L) on day 1. It decreased significantly and reached the minimum 0.91 ± 0.53 (× 109/L) on day 10 (P < 0.05). The experimental group had a lower FN incidence than the control group (P < 0.05). There was also no significant acute esophagitis or pulmonary toxicity. The treatment had no significant effect on PFS (11.4 months vs. 8.7 months, P = 0.958) or OS (23.9 months vs. 17.3 months, P = 0.325) over an 18.6-month median follow-up time. CONCLUSION: PEG-rhG-CSF has good efficacy and safety in preventing hematological toxicity in SCLC patients during CCRT and has no significant effects on PFS or OS.

Burnout and well-being of healthcare workers in the post-pandemic period of COVID-19: a perspective from the job demands-resources model.

BACKGROUND: The present study aimed 1) to examine the effects of epidemic-related job stressors, perceived social support and organizational support on the burnout and well-being of Chinese healthcare workers in the period of COVID-19 regular epidemic prevention and control and 2) to investigate the moderating effects of social support and organizational support on the relationship between job stressors and burnout and well-being within the theoretical framework of the Job Demands-Resources (JD-R) model. METHODS: A sample of healthcare workers (N = 3477) from 22 hospitals in Beijing, China participated in the cross-sectional investigation in October 2020 and reported epidemic-related job stressors, perceived social support, organizational support, burnout, anxiety and depression symptoms. RESULTS: 1) Medical doctors, females, people aged from 30 to 50, and those who worked in the second line during the pandemic reported higher scores of psychological symptoms and burnout in the period of regular epidemic prevention and control; 2) Epidemic-related job stressors positively predicted burnout, anxiety, and depression among healthcare workers; 3) Perceived social support and organizational support were negatively related to reported burnout, anxiety and depression symptoms; 4) Social support reduced the adverse effects of epidemic-related job stressors on anxiety and depression but enhanced the association between stressors and burnout; 5) Organizational support mitigated the adverse effects of epidemic-related job stressors on depression. CONCLUSION: The results shed light on preventing burnout and enhancing the psychological well-being of healthcare workers under epidemic prevention and control measures by reducing epidemic-related job stressors and strengthening personal and organizational support systems.

Changes in the levels of T lymphocytes and inflammatory factors in the peripheral blood of breast cancer patients during postoperative chemotherapy.

BACKGROUND: As one of the main malignant tumors affecting women, the incidence of breast cancer increases year by year. This study aims to analyze the risk factors of infection in breast cancer patients during postoperative chemotherapy by measuring the changes in the levels of T lymphocytes and inflammatory factors in peripheral blood. METHODS: The clinical data of 156 patients who underwent radical mastectomy and postoperative chemotherapy [docetaxel, epirubicin, cyclophosphamide (TEC)] in our hospital from May 2014 to April 2018 were retrospectively analyzed. According to the presence or absence of infection after chemotherapy, patients were divided into the infection group and the normal group. The risk factors of infection during chemotherapy were analyzed by univariate and multiple logistic regression analyses. Serum before surgery, and before and after chemotherapy, was collected to detect the levels of T lymphocytes and inflammatory factors. RESULTS: A total of 36 patients developed an infection during chemotherapy, with an infection rate of 23.08%. The main infection site was the respiratory tract. The main pathogens detected were Gram-negative bacteria and Gram-positive bacteria. The results of univariate analysis showed that there were significant differences in age, diabetes mellitus, clinical TNM staging, white blood cell count (WBC), T lymphocyte subsets CD4+/CD8+, C-reactive protein (CRP) levels, and tumor necrosis factor-α (TNF-α) levels between the 2 groups (P<0.05). Results of logistic regression analysis showed that age ≥60 years old, diabetes mellitus, clinical TNM staging ≥ stage III, WBC <3.5×109/L, CD4+/CD8+ <1.33, TNF-α ≥70 ng/L and CRP ≥60 mg/L were all independent risk factors of postoperative infection (P<0.05). Both before and after chemotherapy, levels of CD3+, CD3+CD4+ and CD4+/CD8+ cells in the infection group were significantly lower than those in the normal group, while levels of CRP, TNF-α and IL-6 were significantly higher than those in the normal group (P<0.05). CONCLUSIONS: Dynamic monitoring of changes in the levels of T lymphocytes and inflammatory factors during chemotherapy may be of clinical value for predicting the risk of infection. Implementing targeted intervention measures for these risk factors may therefore be beneficial for controlling infection.

Effectiveness of extracorporeal shock-wave therapy for frozen shoulder: A protocol for a systematic review of randomized controlled trial.

BACKGROUND: This systematic review aims to explore the effectiveness and safety of extracorporeal shock-wave therapy (ESWT) for patients with frozen shoulder. METHODS: The sources of Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and Websites of Clinical Trials Registry will be searched. All databases and other sources will be searched from inception to the date of the search will be run. Only randomized controlled trials of ESWT for frozen shoulder will be considered for inclusion in this systematic review. Two authors independently screen the studies, extract the data, and evaluate the methodology quality for included trials. If sufficient trials will be included with fair heterogeneity, the data will be pooled, and the meta-analysis will be performed by using RevMan 5.3 software. RESULTS: This systematic review will assess the effectiveness and safety of ESWT for frozen shoulder. The primary outcome includes pain intensity. The secondary outcomes consist of shoulder function, quality of life, and also the adverse events. CONCLUSION: Its findings may provide latest evidence of ESWT for the treatment of frozen shoulder. ETHICS AND DISSEMINATION: No research ethics approval is required in this study, because it is a systematic review and will not use individual data. The results of this study are expected to publish at peer-reviewed journals.

[Isolation and characterization of dendritic cells from normal human esophageal mucosa].

AIM: To investigate the characteristics of dendritic cells (DCs) from normal human esophageal mucosa. METHODS: We collected normal esophageal mucosa samples from healthy individuals using endoscope and isolated mononuclear cells from the samples using Ficoll-Hypaque density gradient centrifugation. DCs were further separated by magnetic-activated cell sorting (MACS) to analyze DCs subsets by flow cytometry. RESULTS: Three mononuclear cell populations were detected in normal human esophageal mucosa: HLA-DR(high)/CD13(low);, HLA-DR(med)/CD13(+); and HLA-DR(-)/CD13(+). HLA-DR(high)/CD13(low); cells expressed the DCs-associated molecules and were referred to as esophageal mucosal DCs. The DCs were immature since they expressed low levels of CD80, CD83 and CD86. CONCLUSION: HLA-DR(high)/CD13(low); cells isolated from the normal human esophageal mucosa were proved to be DCs. DCs can be successfully isolated from esophageal mucosa.