Efficacy and safety of neoadjuvant immunotherapy protocols and cycles for non-small cell lung cancer: a systematic review and meta-analysis.

Objectives: This study evaluated the use of different neoadjuvant immunotherapy cycles and regimens for non-small cell lung cancer. Materials and methods: Databases were searched for articles published up until December 2023. Data on the major pathologic response (MPR), complete pathologic response (pCR), radiological response, treatment-related adverse events (TRAEs), serious adverse events (SAEs), surgical resection, surgical complications, R0 resection, and conversion to thoracotomy were collected. A subgroup analysis was performed according to the treatment regimens and cycles. Stata/MP software was used for statistical analyses. Results: In total, 2430 individuals were assessed from 44 studies. Compared with those following neoadjuvant immunotherapy alone (MPR/pCR/TRAEs/SAEs: ES=0.26/0.07/0.43/0.08, 95% CI: 0.18-0.34/0.04-0.10/0.28-0.58/0.04-0.14), the MPR and pCR rates, incidence of TRAEs and SAEs following neoadjuvant chemoimmunotherapy increased significantly (MPR/pCR/TRAEs/SAEs: ES=0.55/0.34/0.81/0.22, 95% CI: 0.48-0.63/0.28-0.41/0.69-0.90/0.13-0.33, P=0.001/0.002/0.009/0.034). No significant differences were found in the surgical resection, surgical complications, R0 resection, or conversion to thoracotomy. In the chemoimmunotherapy group, no statistically significant differences were found in the MPR and pCR rates, incidence of TRAEs and SAEs in the two-cycle, three-cycle and four-cycle groups (MPR/pCR/TRAEs/SAEs: ES=0.50;0.70;0.36/0.32;0.49;0.18/0.95;0.85;0.95/0.34;0.27;0.37, P=0.255/0.215/0.253/0.848). In the ICIs group, there was little change in the MPR and pCR rates, incidence of TRAEs and SAEs in the two-cycle group compared to the three-cycle group. (MPR/pCR/TRAEs/SAEs: ES=0.28;0.20/0.06;0.08/0.45;0.35/0.10;0.02, P=0.696/0.993/0.436/0.638). The neoadjuvant treatment cycle had no significant effect on surgical resection, surgical complications, R0 resection, or conversion to thoracotomy in both regimens. Conclusion: Neoadjuvant chemoimmunotherapy significantly increased the rate of tumor pathological remission compared to neoadjuvant immunotherapy alone but also increased the incidence of TRAEs and SAEs. The efficacy and safety of neoadjuvant chemoimmunotherapy are found to be favorable when administered for a duration of three cycles, in comparison to both two and four cycles. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023407415.

[Application of Neoadjuvant Chemoimmunotherapy in Resectable NSCLC].

BACKGROUND: For resectable non-small cell lung cancer (NSCLC), the CheckMate-816 study demonstrated that neoadjuvant chemoimmunotherapy increased the rate of complete pathologic response (pCR) by 21.8% compared with chemotherapy alone and resulted in a significant benefit in event-free survival (EFS). This study aimed to investigate the safety and feasibility of this approach in the real world. METHODS: Clinical data from patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy or chemotherapy alone in two centers were analyzed retrospectively, and subgroup analyses were performed for the chemoimmunotherapy group according to treatment cycle. The primary study endpoints were EFS and major pathologic response (MPR), and the secondary study endpoints were pCR, overall survival (OS), treatment-related adverse events (TRAEs), and surgery-related metrics. RESULTS: As of April 2023, 89 patients had been enrolled, including 54 in the chemoimmunotherapy group and 35 in the chemotherapy alone group. MPR was achieved in 31 (57.4%) and 5 (14.3%) patients in the chemoimmunotherapy group and chemotherapy alone group, respectively (OR=8.09, 95%CI: 2.72-24.04, P<0.001); pCR was achieved in 25 (46.3%) patients in the chemoimmunotherapy group and no patient in the chemotherapy alone group (P<0.001). The median follow-up time was 22.1 months. At 24 months, the EFS rates of the chemoimmunotherapy group and the chemotherapy alone group were 77.0% and 56.7%, respectively (P=0.026), and the OS rates were 87.1% and 67.7%, respectively (P=0.020). In the neoadjuvant chemoimmunotherapy group, there was no significant difference between the 1-2 cycles and 3-5 cycles groups in terms of operation time, intraoperative blood loss, and postoperative complications. CONCLUSIONS: Neoadjuvant chemoimmunotherapy was more effective than chemotherapy alone and did not increase the risk associated with surgery. An increase in the number of cycles of neoadjuvant chemoimmunotherapy had no significant effect on the difficulty of surgery.

Effects of Profession-Related Support from Different Sources on Subjective Well-Being Among Chinese Tuition-Free Normal University Students: The Mediation of Intrinsic Motivation for Teaching and Moderation of Dispositional Gratitude.

Background: Tuition-free normal university students (TFNUS) have become an important group in Chinese normal university. The subjective well-being of TFNUS not only affects their own mental health, and decisions to stay in the teaching profession, but also can significantly influence their future student's perception of stress, learning motivation and academic achievement. However, little attention has been paid to the relationship between positive factors and TFNUS's subjective well-being and the underlying mechanism and boundary condition. The purpose of this study is to examine whether, how and when profession-related support from different sources influences TFNUS's subjective well-being. Methods: Based on the Conservation of Resource Theory and Self-Determination Theory, a time-lagged design was used to collect two wave data (N=526), and we use dominance analysis to examine the relative importance of profession-related support from significant others (eg, government, teachers, and parents) in relation to subjective well-being among Chinese tuition-free normal university students, and propose a moderated mediation model to reveal the mediating (intrinsic motivation for teaching) and moderating (dispositional gratitude) effects of this relation. Results: Profession-related government, teacher, and parent support were all positively related to subjective well-being, in a descending order of relative importance were as follows: teacher, parent and government. Furthermore, intrinsic motivation for teaching mediated the relationship between profession-related support and subjective well-being. In addition, dispositional gratitude only moderated the relationship between two sources (teacher and parent, respectively) of profession-related support and intrinsic motivation for teaching. Moreover, dispositional gratitude moderated the strength of the indirect effect of profession-related teacher support and parent support on subjective well-being (through intrinsic motivation for teaching), and the mediated relationship was stronger for those with high (vs low) dispositional gratitude. Conclusion: The profession-related support had positive direct effect on tuition-free normal university students' subjective well-being, as well as indirect effect through intrinsic motivation for teaching. Dispositional gratitude moderated the relationship between of profession-related teacher, parent support and intrinsic motivation for teaching, and the strength of the indirect effect of this support on subjective well-being.

[Relation between partial mechanical injuries and nature of death in high-falling cases: an analysis of 205 cases].

OBJECTIVE: To explore the relation between the behavior psychology analysis of partial mechanical injuries and the nature of death in high-falling cases, and provide reference, for such cases. METHODS: Of 311 death victims of high-falling injuries collected from 2008 to 2013, 205 cases were associated with partial mechanical injuries. The characteristics of injury formation, preliminary crime scene traces, fatal injury of high-falling, and text messages were all retrospectively analyzed. RESULTS: According to the investigation of preliminary crime scene traces, fatal injury of high-falling and text message, there were 86 suicide, 24 accident and 95 uncertainty in the 205 cases. According to the behavior psychology analysis of partial mechanical injuries, there were 80 suicide, 11 accident, and 4 homicide in the 95 uncertainty cases. CONCLUSION: The partial mechanical injuries uncertainly caused by high-falling correlate with the manner of high-falling death. According to the behavior psychology analysis of the partial mechanical injuries in high-falling death cases, the presumption of high-falling death is usually accurate