Objective To explore the effect of the combined sequential application of er-lotinib between the chemotherapy periods on the treatment of the patients with advanced non small cell lung cancer (NSCLC).Methods 45 patients with advanced NSCLC were collected.The pa-tients with the initial treatment were treated with gemcitabine combined with platinum for chemotherapy,while the patients with retreatment were treated with docetaxel or pemetrexed for chemotherapy.Between the chemotherapy periods,the sequential erlotinib therapy was applied to all the patients.The short-term efficacy and the adverse reactions were evaluated and compared. Results The clinical efficacy of the initial treatment patients and the retreatment patients were 27.6% and 18.8% respectively (P >0.05),and the clinical control rate of the initial treatment patients was significantly higher than that of the retreatment patients (P <0.05).The clinical ef-ficacy of the patients with a history of smoking was significantly lower than that of the patients without a history of smoking (P <0.05).The clinical efficacy of the initial treatment patients with age over 65 years old was significantly higher than that of the initial treatment patients with age less than 65 years old(P <0.05).The clinical efficacy of the initial treatment patients with stage Ⅲ b was significantly higher than that of the initial treatment patients with stage Ⅳ (P <0.05).The clinical efficacy of the retreatment patients with adenocarcinoma pathological type was significantly higher than that of the patients without adenocarcinoma pathological type (P <0 .0 5 ).The main adverse reactions were nausea ,diarrhea ,rash ,vomiting and loss of appetite .
Conclusion The clinical efficacy of the combined sequential application of erlotinib between the chemotherapy periods in the treatment of the patients with advanced NSCLC is not such high. Smoking history,age,tumor stage and pathological type may affect its curative effect.Efficacy of this therapy in controlling the disease progress of the initial treatment patients is significant,the adverse reactions are mild,and the tolerance of the patients for the therapy is higher.

Objective To observe and analyze the curative effects of the combined sequential application of erlotinib between the chemotherapy periods in the treatment of the patients with ad-vanced non small cell lung cancer (NSCLC).Methods 45 patients with advanced NSCLC were se-lected as the research objects.The patients of the initial treatment were treated with gemcitabine combined with platinum for chemotherapy and the patients of retreatment were treated with doc-etaxel or pemetrexed for chemotherapy.Between the chemotherapy periods,the sequential erlotinib therapy was applied to all the patients.The short-term curative effects and the adverse reactions were evaluated and compared.Results The clinical efficiency of the initial treatment patients and the retreatment patients were 27.6% and 18.8% respectively.There were no significant differences of short-term curative effects and the clinical efficiency between the initial treatment patients and the retreatment patients (P >0.05),while the clinical control rate of the initial treatment patients was significantly higher than that of the retreatment patients (P <0.05).The clinical efficiency of the patients with a smoking history was significantly lower than that of the patients without smok-ing history(P <0.05).The clinical efficiency of the initial treatment patients with age of 65 years or older was significantly higher than that of the initial treatment patients of age < 6 5 years (P <0.05).The clinical efficiency of the initial treatment patients with stage Ⅲb was signifi-cantly higher than that of the initial treatment patients with stage Ⅳ(P <0.05).The clinical ef-ficiency of the retreatment patients with adenocarcinoma pathological type was significantly higher than that of the patients without adenocarcinoma pathological type (P <0.05).The main adverse reactions of the patients were nausea,diarrhea,rash,vomiting,loss of appetite.Conclusion The clinical efficiency of the combined sequential application of erlotinib between the chemothera-py periods in the treatment of the patients with advanced NSCLC is not high.Smoking history, age,tumor stage,pathological type may affect its curative effect.The effects of this therapy in controlling the disease progress of the initial treatment patients are more significant,the adverse reactions are mild,and the tolerance of the patients for the therapy is higher.

Objective To explore the effect of the combined sequential application of er-lotinib between the chemotherapy periods on the treatment of the patients with advanced non small cell lung cancer (NSCLC).Methods 45 patients with advanced NSCLC were collected.The pa-tients with the initial treatment were treated with gemcitabine combined with platinum for chemotherapy,while the patients with retreatment were treated with docetaxel or pemetrexed for chemotherapy.Between the chemotherapy periods,the sequential erlotinib therapy was applied to all the patients.The short-term efficacy and the adverse reactions were evaluated and compared. Results The clinical efficacy of the initial treatment patients and the retreatment patients were 27.6% and 18.8% respectively (P >0.05),and the clinical control rate of the initial treatment patients was significantly higher than that of the retreatment patients (P <0.05).The clinical ef-ficacy of the patients with a history of smoking was significantly lower than that of the patients without a history of smoking (P <0.05).The clinical efficacy of the initial treatment patients with age over 65 years old was significantly higher than that of the initial treatment patients with age less than 65 years old(P <0.05).The clinical efficacy of the initial treatment patients with stage Ⅲ b was significantly higher than that of the initial treatment patients with stage Ⅳ (P <0.05).The clinical efficacy of the retreatment patients with adenocarcinoma pathological type was significantly higher than that of the patients without adenocarcinoma pathological type (P <0 .0 5 ).The main adverse reactions were nausea ,diarrhea ,rash ,vomiting and loss of appetite .
Conclusion The clinical efficacy of the combined sequential application of erlotinib between the chemotherapy periods in the treatment of the patients with advanced NSCLC is not such high. Smoking history,age,tumor stage and pathological type may affect its curative effect.Efficacy of this therapy in controlling the disease progress of the initial treatment patients is significant,the adverse reactions are mild,and the tolerance of the patients for the therapy is higher.

Objective To observe and analyze the curative effects of the combined sequential application of erlotinib between the chemotherapy periods in the treatment of the patients with ad-vanced non small cell lung cancer (NSCLC).Methods 45 patients with advanced NSCLC were se-lected as the research objects.The patients of the initial treatment were treated with gemcitabine combined with platinum for chemotherapy and the patients of retreatment were treated with doc-etaxel or pemetrexed for chemotherapy.Between the chemotherapy periods,the sequential erlotinib therapy was applied to all the patients.The short-term curative effects and the adverse reactions were evaluated and compared.Results The clinical efficiency of the initial treatment patients and the retreatment patients were 27.6% and 18.8% respectively.There were no significant differences of short-term curative effects and the clinical efficiency between the initial treatment patients and the retreatment patients (P >0.05),while the clinical control rate of the initial treatment patients was significantly higher than that of the retreatment patients (P <0.05).The clinical efficiency of the patients with a smoking history was significantly lower than that of the patients without smok-ing history(P <0.05).The clinical efficiency of the initial treatment patients with age of 65 years or older was significantly higher than that of the initial treatment patients of age < 6 5 years (P <0.05).The clinical efficiency of the initial treatment patients with stage Ⅲb was signifi-cantly higher than that of the initial treatment patients with stage Ⅳ(P <0.05).The clinical ef-ficiency of the retreatment patients with adenocarcinoma pathological type was significantly higher than that of the patients without adenocarcinoma pathological type (P <0.05).The main adverse reactions of the patients were nausea,diarrhea,rash,vomiting,loss of appetite.Conclusion The clinical efficiency of the combined sequential application of erlotinib between the chemothera-py periods in the treatment of the patients with advanced NSCLC is not high.Smoking history, age,tumor stage,pathological type may affect its curative effect.The effects of this therapy in controlling the disease progress of the initial treatment patients are more significant,the adverse reactions are mild,and the tolerance of the patients for the therapy is higher.

Objective: To explore the relationship between glycemic control and visceral adiposity index (VAI) among type 2 diabetes mellitus (T2DM) patients.Methods: A community-based epidemiological field study for patients with T2DM aged ≥ 40 years was conducted in China.Every participant underwent physical examinations, biochemical tests of fasting glucose, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and so on, and a questionnaire, including anthropometric characteristics, lifestyle, disease history, family history, and medication use.Those participants with HbA1c ≥7.0% were classified as the poorly controlled in our analysis of relationship between glycemic control and VAI.Anthropometric characteristics, lifestyle, and biochemical indexes of the participants were compared among the groups of different VAI levels.Logistic models were applied in multiple analysis adjusting for possible confounders.Results: A total of 1 607 patients with T2DM were recruited in our analysis with a mean age of (59.4±8.1) years and an average T2DM duration of (7.0±6.4) years.Among them, 78.3% were on hypoglycemic therapy.The cutoff points of quartiles of VAI were calculated for the males and females, respectively.According to the ascending order of the quartiles of VAI, the participants were divided into four groups, i.e.Q1, Q2, Q3, and Q4.The poor glycemic control rate for these groups were 60.6%, 65.7%, 70.1%, and 71.0%, respectively (Trend χ2=12.20, P<0.001).After adjustment for age, gender, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL-C, smoking, cardio-cerebral vascular disease (CVD) history, hypoglycemic therapy, T2DM duration, and family history of diabetes, the Logistic regression models showed that the glycemic control rate was significantly associated with VAI levels among the patients with T2DM.Compared with the participants in group Q1, the ORs of poor glycemic control for those in groups Q2, Q3, and Q4 were 1.239 (95%CI 0.918 to 1.672), 1.513 (95%CI 1.117 to 2.050), and 1.535 (95%CI 1.128to 2.088), respectively (trend P=0.003).With each quartile increase in VAI, the OR of poor glycemic control was 1.162 (95%CI 1.054 to 1.282).Conclusion: The glycemic control among the patients with T2DM is significantly associated with VAI.High level of VAI is an indicator of poor glycemic control.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of tirzepatide for diabetes mellitus type 2 （T2DM） and long-term weight management， and provide evidence-based basis for clinical drug treatment and health insurance policy formulation. METHODS Computer searches were conducted in Embase， PubMed， the Cochrane Library， CNKI and health technology assessment （HTA） official website from their inception to October 1st 2024 to collect HTA report， systematic review/ meta-analysis and pharmacoeconomic study on tirzepatide for the treatment of T2DM or for weight management. After data extraction and quality evaluation， descriptive analysis was performed on the research results. RESULTS Totally 18 papers were included， including 14 systematic reviews/meta-analyses and 4 pharmacoeconomics studies， and no HTA report was retrieved. In terms of efficacy， most results showed that the tirzepatide 10 mg and 15 mg were significantly better than other glucagon-like peptide-1 （GLP-1） receptor agonists in reducing glycosylated hemoglobin， body weight， and waist circumference （P＜0.05）. In terms of safety， compared with other GLP-1 receptor agonists， tirzepatide did not increase the incidence of gastrointestinal-related adverse events （AE）， the incidence of AE of grade ≥3， or the incidence of severe hypoglycemia （P＞0.05）. However， tirzepatide 15 mg may significantly increased the incidence of hypoglycemia and the rate of discontinuation due to adverse reactions （P＜ 0.05）. In terms of cost-effectiveness， based on the background of foreign pharmacoeconomic studies， tirzepatide was more cost- effective compared to semaglutide and liraglutide in the treatment of T2DM or for weight management. CONCLUSIONS Tirzepatide at doses of 10 mg and 15 mg has good efficacy and safety for the treatment of T2DM and for long-term weight management. However， when using the 15 mg dose of tirzepatide， close monitoring is required due to the risk of hypoglycemia and discontinuation due to adverse reactions it may pose. Based on pharmacoeconomic studies conducted abroad results， tirzepatide exhibits economic advantages.

Objective: To explore the clinical effect of free anterolateral thigh flap in repairing large annular soft tissue defect of lower leg after burn. Methods: From January 2014 to December 2018, 9 patients with large annular soft tissue defects of lower legs after burns were hospitalized in Zhengzhou First People′s Hospital, including 1 case with wounds on both legs. After debridement, area of wounds was 16 cm×11 cm-38 cm×21 cm, and the burn wounds were repaired with free anterolateral thigh flaps in the area of 18 cm×12 cm-32 cm×24 cm. End-to-end anastomosis of posterior tibial vessels or anterior tibial vessels with lateral circumflex femoral vessels was performed in manual way or by microvascular stapler. For the affected legs without condition for anastomosis, the sound medial lower leg flaps with areas of 10 cm×8 cm-15 cm×10 cm were excised and made into skin tubes, the posterior tibial vessels of the flaps were anastomosed with the vessels of free anterolateral femoral flaps, and the wounds of the injured lower legs were repaired by bridge-type cross-over free transplantation of anterolateral thigh flaps. The pedicles were broken 4 to 5 weeks later. The donor site was transplanted with autologous intermediate split-thickness skin graft from thigh. The outcome of the treatment, the number of perforators included in the flaps, and the anastomotic vessel in the recipient area of patients were recorded. The anastomosis time between manual way and microvascular staplers was recorded and compared. The patency of blood vessels, methods of free transplantation, and follow-up condition were recorded. Data were processed with Wilcoxon rank sum test for two independent samples. Results: All the 10 free flaps and skin grafts of 9 patients survived, and all the wounds were closed by primary operation. Seven flaps contained two perforators each, and three flaps contained three perforators each. The anastomotic vessels were posterior tibial vessels in 6 recipient areas and anterior tibial vessels in 4 recipient areas. Microvascular stapler was used to anastomose 12 veins, while 8 veins and 10 arteries were anstomosed manually. The time consumed by the former method was 4.00 (3.55, 4.38) min, significantly shorter than 12.80 (12.13, 13.40) min of the latter (W=78.00, P<0.01). The patency rates of veins and arteries were 100%. There was no vascular crisis due to vascular anastomosis. Three patients underwent bridge-type cross-over free transplantation, while the others underwent conventional free transplantation. Follow-up for 3 to 30 months showed that the donor site of the thigh had good motor function, without numbness or pain, but hypertrophy of scar could be seen. Four patients had slightly overstaffed flaps transplanted in the recipient area of the lower legs, while the other patients were satisfied with their appearance, and the walking function of the affected limbs gradually recovered. Conclusions Free anterolateral thigh flap transplantation is a safe and reliable clinical limb salvage method for the repair of large annular soft tissue defect of lower leg after burn. Intraoperative application of microvascular stapler for venous anastomosis can shorten the time of vascular anastomosis and has great clinical application value.

Objective: To explore the effects of free anterolateral femoral or medial calf flaps in the repair of severe facial burns. Methods: From January 2014 to October 2017, 18 patients with severe facial burns were admitted to Zhengzhou First People′s Hospital, including 12 males and 6 females, aged 15-78 years. Autologous intermediate split-thickness skin grafts were transplanted to replace oral mucosa in 4 patients with perforating cheek defects, and 8 patients underwent early vacuum sealing drainage and autologous intermediate split-thickness skin grafting to reduce the wound area to 14 cm×6 cm-22 cm×14 cm before flap transplantation. The wounds of 15 patients were repaired with free anterolateral femoral flaps, and the wounds of the other 3 patients were repaired with free medial calf flaps. The area of flaps ranged from 16 cm×7 cm to 24 cm×17 cm. The facial artery or superficial temporal artery was anastomosed end-to-end with lateral femoral circumflex artery or posterior tibial artery under microscope routinely and manually, and the two accompanying veins were anastomosed end-to-end by Coupler microvascular anastomat. The donor site was sutured or transplanted with autologous intermediate split-thickness skin graft. The anastomosis time of veins was recorded. The patency rate of vascular was calculated. The survival status of flaps were observed. The recovery of recipient area was observed during follow-up. Results: The anastomosis time of two veins in this group was 6-10 minutes, with an average of 8.5 minutes. The patency rates of veins and arteries were 100%. There was no vascular crisis due to the anastomosis problem. The free flaps survived well in 16 patients; one patient had hemorrhage under the flap 6 hours after operation, and the blood circulation of flaps turned well after hemostasis by surgical exploration; the other patient had 3 cm necrosis at the distal end of flap after operation, and the wound was closed after dressing change and autologous intermediate split-thickness skin grafting. The patients were followed up for 2 to 24 months after discharge. Most of the five senses function recovered. The color and texture of the flaps were not consistent with those of the normal facial skin. Some flaps were slightly swollen. Oral integrity was restored in 4 patients with perforating cheek defect with mouth opening of 2.2-3.5 cm. Conclusions Free anterolateral thigh flaps or medial calf flaps can repair severe facial burn wounds. It takes less time to anastomose venous vessels by microvascular anastomat during operation and can ensure the quality of venous anastomosis.

OBJECTIVE：To i nvestigate the spectrum-effect relationship of analgesic and anti-inflammatory effects of ethyl acetate extract from Zhuang medicine Stahlianthus involucratus from different habitats. METHODS ：Ten batches of S. involucratus from different habitats were used as samples to investigate the anti-inflammatory and analgesic activities of ethyl acetate extracts by xylene induced ear swelling test and acetic acid induced writhing test in mice. HPLC fingerprints of 10 batches of ethyl acetate extract from S. involucratus were established and their similarity was evaluated by using Similarity Evaluation System of TCM Chromatogram Fingerprint （2012 edition），and the common peaks were identified by comparison with the control. The spectrum-effect relationship of anti-inflammatory and analgesic effects of ethyl acetate extract from S. involucratus were analyzed on the basis of Pearson correlation coefficient （auricle swelling degree and writhing times in 15 min as pharmacodynamic indexes ）and Grey relational analysis （inhibition rate of ear swelling and analgesic rate as pharmacodynamic indexes ）. RESULTS ： batches of ethyl acetate extract from S. involucratus had obvious anti-inflammatory and analgesic effects ； inhibition rates of ear swelling in mice were 46.43％-55.16％，and the analgesic rates of mice were 45.56％-52.72％. A total of 18 common peaks were identified in 10 batches of samples ，andthe similarity between them and the control fingerprint was 0.994-0.997. Compared with substance control ，the pea ks 1，2 and 4 were identified as protocatechuic acid ， p-hydroxy- 0771-4953513。E-mail：liangjie1101@126.com benzoic acid and p-hydroxybenzaldehyde，respectively. Results of Pearson correlation analysis showed that peak 10 and peak 18 were significantly negative correlated with auricle swelling degree and writhing times in 15 min（r were values －0.853，－0.738，P values were 0.002，0.015，respectively）. Results of Gray correlation degree analysis showed that the correlation degree of 18 common peaks with inhibition rate of ear swelling and analgesic rate were all greater than 0.65；among them ，peaks 14，1（protocatechuic acid ），17，9，4（p-hydroxybenzaldehyde），2（p-hydroxybenzoic acid ）， 16，7 and 6 showed the relatively high correlation degree （correlation degree ＞0.7）；peak 1（protocatechuic acid ），17，14，9，16，2 （p-hydroxybenzoic acid ）and 4（p-hydroxybenzaldehyde）showed the relatively high correlation degree （correlation degree ＞0.7）. CONCLUSIONS：The ethyl acetate extract of S. involucratus show good anti-inflammatory and analgesic effects. Peak 1 （protocatechuic acid ），2（p-hydroxybenzoic acid ），10，14，17，18 may be its main active ingredients.

OBJECTIVE To study the anti-inflammatory effect and mechanism of the ethanol extract and the drug-containing serum of Zhuang medicine Stahlianthus involucratus on lipopolysaccharide （LPS）-induced RAW264.7 cell inflammation. METHODS The drug-containing serum or blank serum was obtained by intragastrical administration of ethanol extract of S. involucratus （75.35 g/kg） or purified water. Using RAW264.7 cells as objects， RAW264.7 cells were divided into normal control group， LPS group （1 μg/mL）， S. involucratus ethanol extract high-dose， medium-dose and low-dose groups （50， 25， 12.5 μg/mL）， 4% or 15% blank serum groups， 4% or 15% blank serum+LPS groups， 4% or 15% drug-containing serum groups， 4% or 15% drug-containing serum+LPS groups. After culturing for 24 h， cell viability， the contents of nitric oxide tumor necrosis factor α （TNF-α）， interleukinand IL-6 as well as mRNA expressions of Toll-like eceptor 4 （TLR4） and nuclear factor κB （NF- κB） and protein expressions of nitric oxide synthase （NOS） and cyclooxygenase 2 （COX-2） were all detected in each group. 0771-4953513。E-mail：zhuhuagx@163.com RESULTS After culturing for 24 h， there was no statisticalsignificance in the difference of cell viability. Compared with normal control group， the contents of NO， TNF-α， IL-1β and IL-6， mRNA expressions of TLR4 and NF-κB， and protein expressions of NOS and COX-2 were increased significantly in LPS group （P＜0.05）. Compared with 4% or 15% blank serum groups， the levels of above indexes were increased significantly in 4% or 15% blank serum+LPS groups （P＜0.05）. Compared with LPS group， the levels of above indexes were decreased significantly in S. involucratus ethanol extract groups （P＜0.05）. Compared with 4% or 15% blank serum+LPS groups， the levels of above indexes were decreased significantly in 4% or 15% drug-containing serum+LPS groups （P＜0.05）. CONCLUSIONS The ethanol extract and the drug-containing serum of S. involucratus can significantly alleviate LPS-induced inflammatory reaction， the mechanism of which may be associated with inhibiting the activity of TLR4/NF-κB signaling pathway， down-regulating the protein expressions of COX-2 and NOS， and reducing the release of inflammatory factors.