OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of vonoprazan （VPZ） in the treatment of gastroesophageal reflux disease （GERD） by rapid health technology assessment， and provide evidence for clinical decision-making. METHODS English and Chinese databases including PubMed， Medline， Cochrane Library， CNKI， VIP， and Wanfang data as well as the official websites of domestic and international health technology assessment agencies were searched by computer from the database establishment to August 2024. After literature screening， data extraction and quality evaluation of included studies were conducted by two researchers， the results were described and analyzed qualitatively. RESULTS A total of 21 pieces of literature were included， involving 15 systematic reviews/meta-analyses and 6 pharmacoeconomic studies. In terms of efficacy， compared with the control regimen （different doses of VPZ， placebo， other positive controls or combination therapy）， VPZ （mainly 20 mg/d VPZ） significantly improved the total response rate， mucosal healing rate at 2nd week， symptom remission rate， and maintenance rate at 12th and 24th week after mucosal healing （P＜0.05）； when the endoscopic Los Angeles classification was C/D， the effective rate of VPZ was significantly higher than that of the control regimen （P＜0.05）. In terms of safety， there was no significant difference in the incidence of adverse events between VPZ and the control regimen for GERD treatment （P＞0.05）， but the risk of elevated serum gastrin and abnormal liver function caused by long-term use of VPZ was higher than that of the control regimen （P＜0.05）. In terms of cost-effectiveness， compared with rabeprazole， lansoprazole and esomeprazole， VPZ had a cost- effectiveness/cost-utility advantage. CONCLUSIONS VPZ is effective， safe and cost-effective in the treatment of GERD.

Objective To explore dose-effect relationship of biomechanical parameters in treating atlantoaxial joint disor-der by slimming manipulation.Methods From October 2022 to May 2023,18 patients with atlantoaxial joint disorders were treated,including 10 males and 8 females;aged from 24 to 27 years old with an average of(25.50±l.10)years old;CT of cer-vical vertebra showed 16 patients with right side distortion and 2 patients with left side distortion.The mechanical parameters of treatment of atlantoaxial joint disorder by tendon relaxation manipulation were measured by wearing massage manipulation gloves.The magnitude,frequency and mechanical curve of force during tendon relaxation and starting force,pulling force,pulling time and mechanical curve during rehabilitation were quantified,the differences between the affected and contralateral manipulations were compared.Results The maximum force and frequency of Fengchi(GB20)on the affected side were(19.82±2.02)N and(116.83±14.49)times/min,and opposite side were(13.87±2.19)N and(188.89±16.03)times/min,re-spectively.There were statistically difference in the maximum force and frequency of both sides(P＜0.05).The maximum force and frequency of Quepen(ST12)on the affected side were(14.44±3.27)N and(139.06±28.47)times/min,and those on the opposite side were(9.41±1.38)N and(142.50±28.47)times/min.There was difference in maximum force on both sides(P＜0.05).The starting force,turning force and turning time of the affected side were(14.16±5.98)N,(11.56±6.63)N,(0.14±0.03)S,and the contralateral side were(8.94±3.39)N,(8.30±4.64)N,(0.18±0.04)S,respectively.The difference of starting force,turning force and turning time on both sides were statistically significant(P＜0.05).Conclusion By applying a light re-laxation force on the affected side,the mechanical balance between cervical vertebrae could be restored,and recovery trend of atlantoaxial joint disorder could be strengthened.On this basis,the atlantoaxial odontoid process could be reversed by applying a light rotation force,which reflects the characteristics of high safety of the manipulation.

The transmission cycle of echinococcosis was established in 1853.More than 160 years have elapsed since Iceland initiated control measures to break the transmission cycle of echinococcosis in 1863.Control plans have been implemented in more than a dozen countries/territories,and lessons have been learned from failures as well as successes.In this review,we fo-cus on the failure experiences,which have also promoted successes in the control of cystic echinococcosis(caused by the para-site Echinococcus granulosus)in regions including Iceland,New Zealand,Uruguay,Wales(England),Turkana(Kenya),and Sardinia(Italy).The causes of the failures were analyzed,and the effects of health education,dog deworming,and con-trol measures for infected animal slaughter on echinococcosis control are comprehensively summarized.However,no suc-cessful experience has been reported in the control of alveolar echinococcosis(caused by the parasite Echinococcus multilocu-laris).On the basis of the biological characteristics of E.mul-tilocularis parasitization in dogs for a duration of 30 days and larvae parasitization in rodents,the fundamental measure for controlling alveolar echinococcosis is administration of monthly deworming treatments to dogs in high prevalence areas.

Regardless of the underlying etiology, renal fibrosis is the final histological outcome of progressive kidney disease. Unilateral ureteral obstruction (UUO) is an ideal and reproducible experimental rodent model of renal fibrosis, which is characterized by tubulointerstitial inflammatory responses, accumulation of extracellular matrix, tubular dilatation and atrophy, and fibrosis. The magnitude of UUO-induced renal fibrosis is experimentally manipulated by the species chosen, animal age, and the severity and duration of the obstruction, while relief of the obstruction allows the animal to recover from fibrosis. The pathogenesis of renal fibrosis is complex and multifactorial and is orchestrated by activation of renin-angiotensin system (RAS), oxidative stress, inflammatory response, transforming growth factor beta 1-Smad pathway, activated myofibroblasts, cell death (apoptosis, autophagy, ferroptosis, and necroptosis), destruction of intracellular organelles, and signaling pathway. The current therapeutic approaches have limited efficacy. Inhibition of RAS and use of antioxidants and antidiabetic drugs, such as inhibitors of sodium-glucose cotransporter 2 and dipeptidyl peptidase-4, have recently gained attention as therapeutic strategies to prevent renal scarring. This literature review highlights the state of the art regarding the molecular mechanisms relevant to the management of renal fibrosis caused by UUO.

Regardless of the underlying etiology, renal fibrosis is the final histological outcome of progressive kidney disease. Unilateral ureteral obstruction (UUO) is an ideal and reproducible experimental rodent model of renal fibrosis, which is characterized by tubulointerstitial inflammatory responses, accumulation of extracellular matrix, tubular dilatation and atrophy, and fibrosis. The magnitude of UUO-induced renal fibrosis is experimentally manipulated by the species chosen, animal age, and the severity and duration of the obstruction, while relief of the obstruction allows the animal to recover from fibrosis. The pathogenesis of renal fibrosis is complex and multifactorial and is orchestrated by activation of renin-angiotensin system (RAS), oxidative stress, inflammatory response, transforming growth factor beta 1-Smad pathway, activated myofibroblasts, cell death (apoptosis, autophagy, ferroptosis, and necroptosis), destruction of intracellular organelles, and signaling pathway. The current therapeutic approaches have limited efficacy. Inhibition of RAS and use of antioxidants and antidiabetic drugs, such as inhibitors of sodium-glucose cotransporter 2 and dipeptidyl peptidase-4, have recently gained attention as therapeutic strategies to prevent renal scarring. This literature review highlights the state of the art regarding the molecular mechanisms relevant to the management of renal fibrosis caused by UUO.

Objective:To analyze the correlation between elastic modulus of shear wave elastography of periurethral prostatic tissue and serum prostate-specific antigen(PSA)in patients with benign prostatic hyperplasia(BPH).Methods:A total of 200 BPH patients who received treatment in the Second People's Hospital of Hefei from October 2019 to October 2022 were collected by convenient sampling method,and all patients were subjected to ultrasound shear wave elastography and serum PSA examination,and the elastic modulus of periurethral prostate tissue was measured by shear wave elastography,and the mean of them was obtained.They were divided into mild group(96 cases),moderate group(59 cases)and severe group(45 cases)according to the results of the International Prostate Symptom Score(IPSS).At the same time,the related information of 30 cases without prostatic lesions who were selected from the prostate examination population were included into healthy control groups.The correlation between the elastic modulus of periurethral prostatic tissue and serum PSA was analyzed and compared.Results:Statistical analysis showed that there was significant difference in the elastic modulus value of prostate among various groups(F=190.914,P<0.05).Compared with the healthy control group,the elastic modulus values of prostate of the mild,moderate and severe groups were significantly increased,and the differences were significant(t=6.572,14.172,18.441,P<0.05),respectively.Compared with the mild group,the elastic modulus values of prostate of the moderate and severe groups were significantly increased(t=7.853,18.274,P<0.05),respectively.Compared with the moderate group,the elasticity modulus value of prostate of the severe group significantly increased(t=11.371,P<0.05).There was significant difference in serum PSA among BPH patients with different degrees(F=126.143,P<0.05).Compared with the healthy control group,the serum PSA values of the mild,moderate and severe groups significantly increased(t=10.694,14.368,13.804,P<0.001),respectively.Compared with the mild group,the serum PSA values of the moderate and severe group significantly increased(t=6.401,13.047,P<0.05),respectively.Compared with the moderate group,the serum PSA value of the patients in the severe group significantly increased(t=7.293,P<0.001).There was no significant correlation between serum PSA and the elastic modulus of periurethral tissues in the healthy control group(P>0.05).There were significant positive correlation between serum PSA and the elastic modulus of periurethral tissues in the mild,moderate and severe groups(r=0.314,0.296,0.354,P<0.05),respectively.Conclusion:Both serum PSA level and elastic modulus value of periurethral prostate tissue of BPH patients significantly increase,and there is a positive correlation between them.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of vericiguat in the treatment of heart failure （HF） by rapid health technology evaluation method， and provide reference for the selection and decision-making of clinical treatment plans. METHODS Chinese and foreign databases such as CNKI， PubMed and related health technology evaluation websites were searched by computer. Relevant researchers independently screened literature， extracted data， and comprehensively analyzed the results of the included literature based on literature quality evaluation. RESULTS A total of 17 pieces of literature were included， involving 12 systematic reviews/meta-analyses and 5 pharmacoeconomic studies. The effectiveness analysis showed： for HF patients， compared with placebo， vericiguat （10 mg/d） significantly improved the EuroQol five dimensions questionnaire （EQ-5D） index and decreased the rate of hospitalization due to HF （P＜0.05）. For heart failure with reduced ejection fraction （HFrEF） patients， vericiguat reduced the incidence of hospitalization due to HF compared with sodium-glucose cotransporter 2 inhibitor （SGLT2i）（P＜0.05）； compared with angiotensin-converting enzyme inhibitor， vericiguat significantly reduced the occurrence risk of composite endpoints of cardiovascular death or hospitalization due to HF（P＜0.05）. For HFrEF patients with chronic kidney disease， vericiguat had a tendency to reduce the occurrence risk of composite endpoints of cardiovascular death or hospitalization due to HF compared with neurohormone inhibitors. Safety analysis showed： vericiguat did not increase drug-related adverse reactions compared to placebo （P＞0.05）. Economic analysis showed： domestic studies indicated that vericiguat had a higher incremental cost-effectiveness ratio. CONCLUSIONS Vericiguat has good safety and efficacy in the treatment of HF but does not possess an economic advantage in the Chinese population.

Acute cerebral infarction(ACI)has the characteristics of onset nasty and high mortality,and thus the rapid determination of the occurrence and development of ACI plays a key role in the diagnosis,treatment and prognosis of ACI patients.It has shown that the serum level of human haptoglobin(Hp)is related to ACI.In this study,surface enhanced Raman scattering(SERS)combined with immune recognition was applied to establish a quantitative analysis method for serum Hp.Firstly,the SERS substrate of silver nanoparticles was prepared on silicon wafer,and 4-mercaptobenzoic Acid(MBA)was used as a Raman probe by forming Ag—S bond and connecting it on the surface of nanoparticles.The carboxyl group of MBA was linked to amino group of self-made high-affinity antibody through forming CO—NH structure thus forming a SERS self-assembled chip of Hp(Ag/MBA/anti-Hp).Hp in serum could be specifically captured by antibodies on SERS substrate,which caused the shift of SERS characteristic peak of MBA.The results showed that there was a good linear relationship between the logarithm of Hp concentration and the SERS characteristic peak shift of MBA.The detection range was 1-1000 ng/mL(R2=0.988).The Hp concentrations in serum of 90 ACI patients were determined by this method,and the results were consistent with those of ELISA method,which proved the practicability and accuracy of this method.This method was highly specific,simple and convenient,which could realize the specific recognition and quantitative analysis of serum Hp,so as to be an effective means for clinical detection of serum Hp,thus providing a reference for the treatment and prognosis of ACI.

Air Pollution/analysis* ; Environmental Exposure/analysis* ; China/epidemiology* ; Air Pollutants/analysis* ; Particulate Matter/analysis* ; Environmental Monitoring

OBJECTIVE To study the influencing factors for proteinuria in patients with malignant tumors treated with apatinib， then establish and evaluate a risk prediction model based on it. METHODS A total of 120 patients with malignant tumors treated with apatinib in our hospital from January 2020 to December 2022 were selected as the training set， and the clinical data was collected. Univariate analysis and multivariate Logistic regression analysis were used to identify independent risk factors for proteinuria associated with apatinib and then construct a risk prediction model. The predictive value of the model was evaluated by using the receiver operator characteristic （ROC） curve. A total of 34 patients with malignant tumors treated with apatinib from January to December 2023 in our hospital were selected as the validation set， and their clinical data were obtained to cross-validate the accuracy of the prediction model. RESULTS The incidence of proteinuria in the training set of 120 patients was 26.67%. The proportions of patients with smoking history， combined hypertension， apatinib daily dose of ≥500 mg， and alanine aminotransferase level were significantly higher in proteinuria group than those in non-proteinuria group. At the same time，the neutrophilic granulocyte count was significantly lower than that in non-proteinuria group （P＜0.05）. Patients with smoking history and combined hypertension were the independent risk factors for apatinib-induced proteinuria （odds ratios were 5.005 and 5.342， respectively； with 95% confidence intervals of 1.806- 13.872 and 1.227-9.602， respectively； P＜0.05）. The binary Logistic regression model equation for the probability （P） of apatinib- induced proteinuria is expressed as LogitP＝1.610XMH+1.233XSH－1.483 （MH for combined hypertension， SH for the smoking history）， with a model accuracy of 80.0%. ROC curve analysis demonstrated the area under the ROC curve of 0.771， the maximum Youden’s index of 0.474， and the optimal cut-off value for LogitP was 0.159 9， with a sensitivity of 90.6% and specificity of 56.8%. Cross-validation results indicated an overall prediction accuracy of 88.24% for the 34 patients. CONCLUSIONS Combined hypertension and smoking history are independent risk factors for apatinib-induced proteinuria. The constructed risk prediction model has moderate predictive value and can be used to predict the risk of proteinuria in patients with malignant tumors induced by apatinib.