Pulmonary rehabilitation has been shown to be effective in reducing dyspnea and improving exercise capacity and health-related quality of life in people with COPD.COPD patients with varying severity can benefit from pulmonary rehabilitation which includes exercise training,inspiratory muscle training and nutritional intervention,et al.Exercise training is the basis of pulmonary rehabilitation.In the last decade,new strategies have been developed to enhance the effects of pulmonary rehabilitation,which include promoting exercise and activity,education and self-management,psychosocial intervention.Although pulmonary rehabilitation has traditionally been provided in stable COPD patients,pulmonary rehabilitation could be started as soon as infection is controlled for AECOPD patients.As pulmonary rehabilitation is administrated,the patients should be encouraged to do exercise as much as possible with different kind of training.

Objective To observe the performance of two-dimensional echocardiography and CDFI of metastatic cervical lymph nodes in nasopharyngeal carcinoma before and after induction chemotherapy,and to predict the short-term effect of the lymph nodes after sequential chemoradiotherapy.Methods Forty patients with sixty-five metastatic cervical lymph nodes which were confirmed as nasopharyngeal carcinoma by biopsy and CT were studied.CDFI was used to observe its size,the peak systolic velocity (PSV),resistivity index (RI),and record its classification of blood flow before and after induction chemotherapy,after radiotherapy 1 to 2 months for ultrasound,respectively,and the measured values and short-term effect in cervical lymph node metastasized were compared.Results According to the changes of blood supply after induction chemotherapy,lymph nodes were divided into three groups,the group of improve blood supply was given priority (55 ％),blood supply to reduce and no change groups were 23 ％,22％,respectively.After induction chemotherapy and sequential radiotherapy,all lymph nodes were narrow,regression rate after induction chemotherapy in blood supply to reduce,improve and no change groups were 52％,36％,25％,respectively,the regression rates of sequential chemoradiotherapy were 90％,81％,70％,respectively,among three groups are in degressive tendency,differences were significant (P ＜ 0.05).The blood supply changes after induction chemotherapy related well with the regression rate of chemotherapy(r =0.572,P =0.000) and sequential radiotherapy(r =0.553,P =0.000).The regression rate of chemotherapy related well with the regression rate of sequential chemoradiotherapy(r =0.621,P =0.000).After chemotherapy three groups of lymph node RI decreased,the difference was significant compared with that before treatment (P ＜ 0.05).After chemotherapy the groups to reduce and improve of PSV had significant differences compare with that before treatment (P ＜ 0.05),the group of blood supply no change of PSV had no significant difference (P ＞ 0.05).Conclusion Application of CDFI can clearly and accurately observe changes of metastatic cervical lymph nodes from nasopharyngeal carcinoma before and after induction chemotherapy,and the changes of blood supply and size after induction chemotherapy can predict the short-term effect after chemoradiotherapy.

We have analyzed the current status of recognization and qualification of orphan drugs in China and abroad, looking at the aspects of the authority institutions, identification and qualification process, and the number of orphan drugs identified and available in the market. By comparing and analyzing horizontally the differences in orphan drugs identification between representative developed countries vs. some developing countries, we discuss the inadequacy of orphan drugs supervision in China. We introduce the advanced experience from the developed countries and some developing countries to provide suggestions for the identification and management of orphan drugs, hoping to speed up the process of development and market availability of orphan drugs and to maximize patient's accessibility to treatment in China.

OBJECTIVE To evaluate the cost -effectiveness of tislelizumab in the second -line treatment of advanced or metastatic esophageal squamous cell carcinoma （ESCC）in China .METHODS A three -state Markov model was constructed to assess the cost -effectiveness of tislelizumab versus chemotherapy in the second -line treatment of advanced or metastatic ESCC and programmed death receptor 1（PD-L1）positive patients . The cycle length of the model was 1 month，and the time horizon of the model was set as 10 years. The discount rate of cost and utility was 5%. One-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the base -case analysis results . RESULTS The results of the base-case analysis showed that compared with chemotherapy ，the incremental cost -effectiveness ratio （ICER）of tislelizumab in the second-line treatment of advanced or metastatic ESCC and PD -L1-positive patients were 26 864.01 yuan/QALY and 37 510.07 yuan/QALY，respectively，which was much lower than 1 time per capita gross domestic product （GDP）in 2021（80 976 yuan）. Results of scenario analysis showed that the ICER was less than 1 times per capita GDP ，regardless of the chemotherapy regimens（paclitaxel，docetaxel or irinotecan ）used. With the extension of the simulation time limit ，the ICER of tirelizumab regimen gradually decreased ，and the reduction rate gradually E-mail：lishunping@sdu.edu.cn decreased，but they were all less than 1 time China ’s per capita GDP in 2021. The results of the one -way sensitivity analysis showed that the 3 parameters with the most significant impact on the ICER were progression -free survival of tislelizumab group ，price of tislelizumab ，and the proportion of patients receiving follow-up treatment in the tislelizumab group . The results of the probability sensitivity analysis showed that the probability of tislelizumab with cost -effectiveness in the treatment of advanced or metastatic ESCC patients and PD -L1-positive patients were 99.09% and 99.94%，respectively，when using 3 times per capita GDP as the willingness -to-pay threshold . CONCLUSIONS Tislelizumab has economic advantages over chemotherapy alone in the second -line treatment of advanced or metastatic ESCC patients.

OBJECTIVE To review the current research progress on pharmacoeconomics evaluation related to spinal muscular atrophy （SMA）， in order to provide valuable insights for clinical treatment， screening and medical insurance payment decision- making. METHODS A computerized search was conducted across multiple databases including PubMed， Web of Science， Embase， Scopus， Cochrane Library， EBSCOhost， CNKI， VIP， CBM and Wanfang database as well as other important health technology assessment （HTA） websites， such as National Institute for Health and Care Research，International Society of Technology Assessment in Health Care， Agency for Healthcare Research and Quality， etc. The pharmacoeconomics evaluation studies related to SMA were collected from the inception to December 31st， 2023. The literature/reports were rigorously screened based on predefined inclusion and exclusion criteria by two researchers， and the essential information from the included literature/ reports was extracted using Excel 2019. The quality of the included literature/reports was evaluated by Consolidated Health Economic Evaluation Reporting Standards 2022. RESULTS Finally， 9 articles and 15 HTA reports were included， with overall good quality of literature， but poor quality of HTA reports. There were a total of 24 studies on the pharmacoeconomics evaluation of SMA， including treatment options such as nusinersen sodium， sovaprevir， risperidone， and best supportive therapy.The review results showed that nusinersen sodium was not cost-effective in the treatment of SMA； there was no consensus on the economic viability of treatment options such as risperidone and sovaprevir； newborn/prenatal screening combined withmedication therapy was cost-effective. CONCLUSIONS newborn/prenatal screening combined with SMA medication therapy demonstrates economic advantages. It is suggested to further investigate the cost-effectiveness of new SMA drugs and SMA screening in China， taking localization parameters and medical insurance prices into account， and gradually incorporate SMA screening into the scope of neonatal genetic disease detection， in order to alleviate the financial burden of patients’ families and healthcare systems.