Objective:To evaluate the success rate and influencing factors of auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube in oldest-old patients.Methods:A case series study was conducted in those elderly hospitalized patients who met the indications for naso intestinal intubation from January 2019 to May 2021 in China-Japan Friendship Hospital. Auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube was implemented. In addition, abdominal X-ray imaging was performed to confirm the location of the catheter tip. The primary indicators included were the success rate and the first attempt success rate of nasojejunal tube placement;, while the secondary indicators included were the number of attempts and the time of insertion. The rate of operational-related adverse events was ustreated as to evaluate the indicator of safety. Logistic regression analysis was used to conduct multi factor analysis.Results:The total success rate and the first-attempt success rate of tube implantation reached were 90.1%(73/81) and 85.2%(69/81), respectively. The mean attempt per individual patient was (1.2 ± 0.2) times for each patient. The median length of operation time was 40.0(27.0, 45.0) minutes, more specifically, among which the median length time of nasogastric and gastrojejunal placement was 20.0(15.0, 25.0) and 18.0(12.5, 20.0) minutes, respectively; while the median lengthtime of nasogastric placement was greaterhigher than that of gastrojejunal placement ( Z = -2.78, P<0.05). As suggested by multivariate analysis, indicated that the conscious conditions of patients had a signific antlyimpact affect on the success rate of for tube implantation ( OR = 19.25, 95% CI 1.24-299.63, P<0.05). In addition, the incidence rate of operational-related adverse events was 37.0%(30/81). By contrast, there were no serious adverse events occurring during the study period. Conclusions:The auscultation-assisted bedside blind placement of the nasojejunal feeding tube technique is effective and safe for early nutrition support in oldest-old patients in terms of early nutritionsupport, the success rate of which is significant largely affected by the patients′ conscious conditions of patients.

Objective To construct a survival prediction model for the patients with extramedullary plasmacytoma (EMP),and to evaluate its application value.Methods The data of the patients diagnosed as EMP from 2000 to 2019 were collected from the National Cancer Institute's Surveillance,Epidemiology,and End Results (SEER) database.Random forest algorithm was used to screen variables,multivariate Cox pro-portional hazards regression model was used to determine the independent risk factors of EMP prognosis,and a nomogram model was constructed based on these factors.The total score of the patients was calculated ac-cording to the nomogram model,and the total samples were divided into the low,medium and high risk groups according to the optimal cutoff value by using X-tile software,and the Kaplan-Meier survival curves of the three groups were analyzed.The predictive performance of the model was evaluated using area under the curve (AUC) of time-dependent receiver operating characteristic (t-ROC) curve,AUC after X years N repeated K-fold cross-validation,calibration curve,and decision curve analysis (DCA).Results A total of 1458 patients with EMP were included,including 796 cases of deletions and 662 cases of death.In the deletion and deaths groups,the majority were aged 60-<75 years old (35.4％,41.2％),male (63.1％,66.3％),white race peo-ple (81.3％,80.4％),and married (68.2％,59.4％).Finally,age (45-<60 years old/60-<75 years old/≥ 75 years old),marital status (single/others),non-primary malignant tumor,and without surgery and radio-therapy were determined to be the independent risk factors for the survival of EPM patients (P<0.05).Based on the above independent risk factors,a survival prediction model was constructed,and a nomogram was drawn.According to the optimal cutoff value,the total sample was divided into the score of 0-96 group (low risk group),score of 98-135 group (medium risk group) and score of 139-191 group (high risk group).The Kaplan-Meier survival analysis revealed that there was statistically significant difference in the survival time a-mong the three groups (P<0.0001).AUC of t-ROC curves for 1,3,5 years and AUC after cross-validation all were>0.7,indicating that the model had a good degree of differentiation.The calibration curves suggested a good consistency between the prediction and practical over survival rate,and DCA indicated that the model could improve the clinical benefits.Conclusion The constructed survival prediction model for EMP patients based on the SEER database could help the clinicians to identify the prognostic risk factors and predict the o-verall survival rate of the patients.

OBJECTIVE To compare five com monly used judgment criteria for potentially inappropriate medication （PIM）in the elderly ，and to provide reference for clinical selection of appropriate PIM evaluation tools for the elderly. METHODS From the aspects of applicable age ，content and scale characteristics ，five commonly used PIM judgment criteria for the elderly at home and abroad were analyzed and compared ，namely Beer ’s criteria ，STOPP/START v 2 criteria，ACOVE 3 criteria，PIM-Check criteria and“Judgment Criteria for Potentially Inappropriate Medication for Chinese Elderly ”（Chinese criteria ）. RESULTS The five standards both overlapped and focused in terms of scale characteristics. In each study ，the incidence of PIM was different according to different standards. Proton pump inhibitors ，diuretics，non-steroidal anti-inflammatory drugs and anticoagulants were the most frequently occurring PIM drugs for the elderly. CONCLUSIONS Combining with the specific conditions of patients and fully considering the benefits and risks of treatment ，rational selection and combination of five PIM judgment criteria ，and necessary supplements to my country ’s PIM judgment criteria ，will help clinicians and pharmacists to improve the efficacy and safety of the medication in the elderly patients.

OBJECTI VE To introduce the evaluation system for clinical value of antineoplastic agents at home and abroad ，and to provide reference for continuous improvement of clinical value-oriented antineoplastic agents development and research guideline in China. METHODS The suggestions were put forward to improve the evaluation system for clinical value of antineoplastic agents in China by consulting the relevant data of evaluation system for clinical value of antineoplastic agents at home and abroad and domestic antineoplastic agents R&D and management policies ，sort outing and analyzing comparatively their dimensions ， perspectives，target audiences ，application scope ，advantages and disadvantages. RESULTS & CONCLUSIONS Seven foreign value evaluation systems （value assessment framework of American Society of Clinical Oncology ，clinical benefit scale of European Society of Clinical Oncology ，value evaluation framework of American Institute of Clinical and Economic Evaluation ， etc.）had their own characteristics and unique advantages under different settings ；several value evaluation systems differed in the criteria for defining value ，depending on the perspective and population they focus on. The value dimensions were constantly changing dynamically in response to scientific values and social needs ，including not only safety ，efficacy and cost-effectiveness ， but also innovation ，fairness，quality of life attributes. Some evaluation systems adopted value assessment tools that followed the trend of the information age in the presentation form and assessment mode ，which promoted shared decision-making between doctors and patients. Combining the characteristics of foreign value evaluation system and the current situation of development and application of antineoplastic agents in China ，we can have a deeper understanding of drug efficacy ，safety，quality of life ，research and development cost and pricing in the future. Antineoplastic 2021-10-28） agents will have a more reasonable position to solve the unmet needs of patients from the perspectives of drug research and development， clinical application ， drug accessibility and fairness.

OBJECTIVE To evaluate the cost-effectiveness of clopidogrel versus aspirin monotherapy regimens for secondary prevention of ischemic stroke and to provide economic evidence and reference for clinical medication and decision-making. METHODS Based on the CAPRIE trial， a Markov model was constructed； the probabilities of risk events， health utility values， and costs of risk event management were obtained from relevant literature. The cycle length was 6 months， and the time horizon was 10 years. A discount rate of 5% per year was applied. The primary outcomes were total costs， quality-adjusted life-years （QALYs）， and incremental cost-effectiveness ratio （ICER）. Cost-utility analysis was performed for above 2 regimens by using TreeAge Pro software. The one-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to validate the robustness of the analyses. RESULTS Compared with the aspirin regimen （325 mg/d of CAPRIE trial dose）， the ICER values of clopidogrel regimen for secondary stroke prevention for 10 years， 20 years and 30 years were 4 284.06， 4 201.20 and 3 986.78 yuan/QALY， respectively， which were E-mail：liuxiaoyanrj@sjtu.edu.cn all less than the willing-to-pay （WTP） threshold of one time 。 China’s per capita gross domestic product （GDP） in 2021. E-mail：scilwsjtu-wb@yahoo.com Compared with the aspirin regimen （clinically recommended dose in China， 100 mg/d）， the ICER values of clopidogrel regimen for stroke secondary prevention for 10 years， 20 years and 30 years were 58 238.27， 42 164.72 and 36 164.77 yuan/QALY， respectively， which were all less than WTP threshold. When comparing with aspirin regimen of 325 mg/d， results of one-way sensitivity analysis showed that the cost of clopidogrel and aspirin， probability of the first recurrence of ischemic stroke were sensitive factors of model. Results of probabilistic sensitivity analysis showed that when WTP was set at one time GDP per capita in China in 2021， clopidogrel had a probability of being cost- effective of about 66.5%. Results of scenario analysis showed that neither changing the time horizon to 10， 20 or 30 years nor using different doses of aspirin （50， 100， 150， 200 or 250 mg/d） would not alter any conclusions. CONCLUSIONS Compared with aspirin monotherapy， clopidogrel monotherapy is more cost-effective for secondary prevention of ischemic stroke.