Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
ObjectiveTo understand the effect of programmed death-1 (PD-1) inhibitors on defective mismatch repair (dMMR) / microsatellite instability-high (MSI-H) advanced colorectal cancer (CRC). MethodThe literature of recent research relevant PD-1 inhibitors in the utility for patients with dMMR/MSI-H advanced CRC was reviewed and summarized. ResultsAt present, there were many studies exploring the utility of anti-PD-1 inhibitors for the treatment of dMMR/MSI-H advanced CRC (including locally advanced CRC and metastatic CRC), and some studies were still in trials. Studies had consistently shown that the use of PD-1 inhibitors in dMMR/MSI-H advanced CRC as first-line or subsequent therapy, as well as in the neoadjuvant setting, leading to significant survival benefits. These benefits were particularly notable in cases of dMMR/MSI-H metastatic CRC with concurrent BRAF/RAS mutations and in the context of neoadjuvant immunotherapy aimed at organ preservation in locally advanced dMMR/MSI-H CRC. Moreover, there were numerous studies exploring “dual immunotherapy”, and most studies found that its efficacy was superior to that of single immunotherapy. However, the more adverse events were reported by the “dual immunotherapy” compared to the single immunotherapy. ConclusionsOverall, based on results of the literature reviewed, PD-1 inhibitors have shown significant clinical benefits in dMMR/MSI-H advanced CRC, but there are still more issues that need to be further explored, such as discovering more first-line PD-1 inhibitors, overcoming drug resistance and adverse events. Future clinical practice should prioritize more precise individualized identification and the application of more effective combination therapy regimens to further optimize outcomes for patients with dMMR/MSI-H advanced CRC.
ObjectiveTo observe the changes of choroid, macular microcirculation and retinal light sensitivity (MS) in people with different degrees of myopia and emmetropia, and to analyze the relationship between them and the axial length (AL).MethodsA cross-sectional observational study. From May 2019 to November 2020, 142 people (142 eyes) of different degrees of myopia and volunteers from Nanchang Aier Eye Hospital were included in the study. All subjects underwent comprehensive optometry, OCT angiography (OCTA), micro-perimetry examination, and axial length (AL) measurement. A frequency domain OCTA instrument was used to measure the blood flow density of the superficial retinal capillary plexus (SVD), the blood flow density of the deep capillary plexus (DVD), the area of the foveal avascular zone (FAZ) and the choroidal capillaries in the 6 mm×6 mm area of the macula, and percentage of vascular blood flow blank area (FD). The macular integrity assessment instrument was used to measure macular 10° retinal MS and macular fovea 2°, 4° fixation rate (P1, P2), 63% and 95% hyperbolic ellipse area (BCEA). Pairwise comparisons between groups were tested by the least significant difference method.ResultsAmong 142 eyes, 68 eyes were in male, 74 eyes were in female. According to different equivalent spherical powers (SER), subjects were divided into emmetropia group, low myopia group, moderate myopia group, and high myopia group, with 31 eyes, 36 eyes, 44 eyes, and 31 eyes, respectively. Compared with SER (H=132.776) and AL (F=61.118) of the tested eyes in the 4 groups, the difference was statistically significant. The SVD (P=0.003, 0.002, 0.003) and DVD (P＜0.001,＜0.001, P=0.001) of the emmetropia group, low myopia group, and moderate myopia group were higher than those of the high myopia group, and the difference was statistically significant. The FAZ area of the emmetropia group was higher than that of the moderate myopia group, the difference was statistically significant (P=0.013). The FD percentage of choroidal capillaries in the moderate myopia group and the high myopia group was higher than that of the emmetropia group, the difference was statistically significant (P=0.011, 0.030). MS in the high myopia group was significantly lower than that in the emmetropia group, low myopia group, and moderate myopia group, the difference was statistically significant (P＜0.001,＜0.001, P=0.035). Compared with 63% BCEA, 95% BCEA, P1 and P2 among subjects in the emmetropia group, low myopia group, moderate myopia group, and high myopia group, the difference was not statistically significant (H=6.936, 7.041, 5.450, 4.239; P>0.05). The results of correlation analysis showed that the macular area SVD (r=－0.256, P=0.002), DVD (r=－0.465, P＜0.001), FAZ area (r=－0.308, P＜0.001) were negatively correlated with AL. The percentage of FD of choroidal capillaries was positively correlated with AL (r=0.170, P=0.043). Retinal MS was positively correlated with SVD (r=0.252, P=0.003), DVD (r=0.298, P＜0.001), FAZ area (r=0.334, P＜0.001), it was negatively correlated with AL (r=－0.439, P＜0.001), it was not related to the percentage of FD of choroidal capillaries (r=－0.061, P=0.473).ConclusionsWith the increase of myopic refractive power and AL, the macular area SVD, DVD, and retinal MS all show a downward trend. The decline of retinal MS is related to the decrease of SVD and DVD.