OBJECTIVE To evaluate the cost-effectiveness of anlotinib combined with penpulimab versus sorafenib as first- line treatment for unresectable hepatocellular carcinoma （uHCC） from the perspective of China’s healthcare system. METHODS Based on data from the APOLLO study， a partitioned survival model was established with a 21-day model cycle to simulate patient survival status over 10 years under anlotinib combined with penpulimab regimen or sorafenib monotherapy. Quality-adjusted life year （QALY） was used as the core evaluation parameter to assess the incremental cost-effectiveness ratio （ICER） of different treatment regimens. Using 3 times China’s per capita gross domestic product （GDP） in 2024 （287 247 yuan/QALY） as the willingness-to-pay （WTP） threshold， cost-utility analysis was performed to evaluate the cost-effectiveness of the treatment regimens. Sensitivity analysis was conducted to validate the robustness of the baseline analysis conclusion. Scenario analysis was performed to consider the impact of anlotinib and penpulimab assistance programs on the results； the price reduction of penpulimab to ensure the cost-effectiveness of the combination regimen was examined under varying WTP thresholds （specifically， 1， 2， and 3 times China’s per capita GDP in 2024）. RESULTS The baseline analysis revealed that the ICER of anlotinib combined with penpulimab regimen relative to the sorafenib regimen was 338 611.20 yuan/QALY， which exceeded the WTP threshold set in this study. Univariate sensitivity analysis indicated that the utility value of progression free survival and penpulimab price significantly influenced the baseline analysis results. Probabilistic sensitivity analysis validated the robustness of the baseline results. The results of scenario analysis indicated that when considering the assistance programs for anlotinib and penpulimab， the obtained ICER values were all below the WTP threshold set at 3 times China’s per capita GDP in 2024. When the price of penpulimab was reduced by 58%， 35%， and 13%， the ICER values were below the WTP threshold， which was 1， 2 and 3 times the per capita GDP of China in 2024， respectively. CONCLUSIONS From the perspective of China’s healthcare system， anlotinib combined with penpulimab regimen for first-line treatment of uHCC lacks cost-effectiveness compared to sorafenib regimen. However， this conclusion would be reversed if the anlotinib and penpulimab assistance programs are taken into account or if the price of penpulimab is reduced by more than 13% and above.

OBJECTIVE To evaluate the cost-effectiveness of amivantamab combined with lazertinib （hereinafter referred to as “AL”） regimen as first-line treatment for EGFR -mutated advanced non-small cell lung cancer （NSCLC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was established based on updated data from the MARIPOSA study， with a 10-year time horizon and 28-day cycles. The primary outcome index was quality adjusted life year （QALY）， and the willingness-to-pay （WTP） threshold was set at three times China’s per capita GDP in 2024 （287 247 yuan/QALY）. Cost-utility analysis was used to calculate the incremental cost-effectiveness ratio （ICER） of AL regimen versus osimertinib monotherapy regimen as first-line treatment for EGFR -mutated advanced NSCLC. One-way and probabilistic sensitivity analyses were performed to test model robustness. Scena rio analyses were conducted to explore the impact of utility values for different health states on the outcomes and determine the required price reductions of amivantamab and lazertinib to achieve cost-effectiveness. RESULTS Compared with the osimertinib monotherapy regimen， the ICER for the AL regimen as first-line treatment for advanced EGFR -mutated NSCLC was 2 062 096.15 yuan/QALY， significantly exceeding the WTP threshold established in this study. One-way sensitivity analysis revealed that the utility value of progression-free survival state and the price of amivantamab were the primary factors influencing the ICER. Probabilistic sensitivity analysis revealed that the AL regimen only became cost-effective when the WTP threshold was set at 2 050 000 yuan/QALY. Scenario analysis indicated that altering the utility value still rendered the AL regimen non-cost-effective. When amivantamab （350 mg） prices decreased by 80%， 85%， and 90% respectively， lazertinib （80 mg） prices would need to decrease by 95.97%， 40.63%， 5.29%， respectively. This would enable the AL regimen’s ICER to consistently fall within the WTP threshold established in this study. CONCLUSIONS At the WTP threshold established in this study， the AL regimen does not demonstrate cost-effectiveness for first-line treatment of advanced EGFR -mutated NSCLC compared to the osimertinib monotherapy regimen. Significant price reductions for both drugs would be required to alleviate the financial burden on patients.

OBJECTIVE To evaluate the cost-effectiveness of culmerciclib combined with fulvestrant as second-line treatment for patients with hormone receptor-positive（HR+）/human epidermal growth factor receptor 2-negative （HER2–） locally advanced or metastatic breast cancer， within the context of the Chinese healthcare system. METHODS A partitioned survival model was established based on the CULMATE-1 study， with a simulation time horizon set at 15 years and a cycle length of 28 days. The incremental cost-effectiveness ratio （ICER） of culmerciclib combined with fulvestrant versus fulvestrant monotherapy as second-line treatment for HR+/HER2– breast cancer was calculated. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. Meanwhile， scenario analysis of culmerciclib price reduction was conducted； the required price reduction and price to reach the willingness-to-pay （WTP） threshold in this study were calculated. RESULTS The results of the base-case analysis indicated that， compared with the fulvestrant monotherapy regimen， culmerciclib combined with fulvestrant yielded an additional 0.823 quality-adjusted life year （QALY）， with a corresponding ICER of 371 696.26 yuan/QALY， which exceeded the WTP threshold （199 330 yuan/QALY）. The results of the univariate sensitivity analysis indicated that the cost of culmerciclib， the discount rate， the utility values for progression disease and progression free survival status were significant factors influencing the ICER； both the univariate sensitivity analysis and the probabilistic sensitivity analysis validated the robustness of the model results. Scenario analysis indicated that when the price of culmerciclib was reduced by 30%， 55% and 85% respectively， the corresponding ICER values fell below 3， 2， and 1 times China’s per capita GDP in 2025， with the probability of cost-effectiveness being 3.00%， 94.90%， 100%. When the cost of culmerciclib （60 mg） was reduced by 52.6% to 50.96 yuan， the ICER value met the WTP threshold established in this study. CONCLUSIONS When the WTP threshold is set at twice China’s per capita GDP in 2025， second-line treatment with culmerciclib combined with fulvestrant for HR+/HER2– locally advanced or metastatic breast cancer does not exhibit cost-effectiveness advantage over fulvestrant monotherapy. Therefore， a reasonable price reduction is required to alleviate the financial burden on patients.

OBJECTIVE To evaluate the cost-effectiveness of sacituzumab tirumotecan （ST） versus chemotherapy treatment physician’s choice （TPC） as second-line and later-line treatment for metastatic triple-negative breast cancer （mTNBC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was constructed based on the OptiTROP-Breast 01 trial， with a cycle length of 4 weeks and a time horizon of 10 years， applying a 5% discount rate. Quality adjusted life year （QALY） and costs were used as outcome measures， and the incremental cost-effectiveness ratio （ICER） of ST versus TPC for second-line and later-line treatment of mTNBC was calculated. Sensitivity analyses were conducted to validate the robustness of the base-case results. RESULTS At a willingness-to-pay threshold （WTP） of 3 times China’s 2024 per capita gross domestic product （GDP） （287 247 yuan/QALY）， patients receiving ST gained incremental utility （0.42 QALY） at a higher cost， yielding an ICER of 205 562.07 yuan/QALY， which was lower than WTP， indicating that ST was more cost-effective compared to TPC. One-way sensitivity analysis revealed that key factors influencing the ICER included the utility value of progression-free survival and the price of ST. Probabilistic sensitivity analysis and scenario analysis showed that the base-case results were robust. CONCLUSIONS From the perspective of China’s healthcare system， at a WTP of 3 times China’s per capita GDP， ST is more cost-effective than TPC as second-line and later-line treatment for mTNBC.

OBJECTIVE: To review the application and progress of unilateral biportal endoscopy (UBE) technology in the treatment of cervical degenerative diseases, and to provide reference for clinical treatment decisions. METHODS: The literature related to UBE technology in the treatment of cervical spondylotic radiculopathy (CSR) and cervical spondylotic myelopathy (CSM) at home and abroad was extensively reviewed, and the surgical methods, indications, effectiveness, and safety were analyzed and summarized. RESULTS: UBE technology is effective in the treatment of CSR and CSM, and has the advantages of good surgical field, reducing the injury of the posterior structure of the cervical spine, and protecting the facet joint process, but in general, the indications are relatively narrow, limited to single-segment or adjacent double-segment lesions, and the requirements for the operator are relatively high, and the learning curve is long. CONCLUSION UBE technology can be applied to the treatment of CSR and CSM, but it needs to be carried out by experienced UBE surgeons for specific cases.
Humans ; Cervical Vertebrae/surgery* ; Endoscopy/methods* ; Radiculopathy/surgery* ; Spondylosis/surgery* ; Decompression, Surgical/methods* ; Spinal Cord Diseases/surgery* ; Treatment Outcome

Purpose To explore the role and mechanism by which the forkhead box C1(FOXC1)promoter up-stream transcript(FOXCUT)regulates proliferation and invasion of non-small cell lung carcinoma(NSCLC)cells.Methods Bioinformatic analysis and RT-qPCR were used to quantify FOXCUT expression in NSCLC tissues.After FOXCUT knockdown in NSCLC cell lines,cell proliferation was examined using CCK-8 and EdU assays,and invasion was evaluated by Transwell assay.The expression of E-cadherin,vimentin,N-cadherin,and FOXC1 was detected by Western blot.FOXCUT-silenced H460 cells were constructed using lentiviruses and subcutaneously injected into nude mice to observe tumor growth.To rescue FOXC1 expression,an FOXC1 expression plasmid was transfected into FOX-CUT-knockdown cells.LncBook 2.0,ENCORI,and TargetScan databases were queried to predict miRNAs that inter-act with FOXCUT and FOXC1.Results FOXCUT expression was significantly higher in NSCLC tissues than in normal lung tissues(normal:0.24±0.22 vs NSCLC:0.68±0.76,t=5.94,P＜0.001),and patients with high FOXCUT expression had a poorer prognosis(P＜0.01).FOXCUT interference markedly repressed NSCLC cells' proliferation and invasion(P＜0.01).FOXCUT knockdown significantly upregulated E-cadherin and downregulated vimentin and N-cadherin(P＜0.01).In vivo,FOXCUT-silenced cells formed significantly smaller tumors in nude mice(P＜0.01).FOXCUT knockdown markedly reduced FOXC1 expression(P＜0.01).Overexpression of FOXC1 in FOX-CUT-depleted cells rescued cell proliferation(P＜0.01).Bioinformatic analysis identified 8 miRNAs potentially co-regulated by FOXCUT and FOXC1.Conclusion Knockdown of FOXCUT restrains NSCLC cell proliferation and inva-sion,possibly through suppression of FOXC1 expression.

Objective To evaluate the cost-effectiveness of deucravacitinib in the treatment of moderate to severe plaque psoriasis from the perspective of the Chinese health system.Methods Based on POETYK PSO-1 study and related cost and utility data,a decision tree combined with Markov model was established.The model period was 10 years,and the output indicators of the model were cost and quality-adjusted life year(QALY).The evaluation index of the model was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay threshold(WTP)was 3 times of China's per capita GDP in 2023.Sensitivity analysis was performed to evaluate the robustness of the model results.Results The incremental utility and incremental cost were 0.598QALYs and 130 677.51 yuan(RMB),respectively.The ICER of the two strategies was 218 487.11 yuan(RMB)per QALY gained,which was less than 3 times GDP per capita in 2023.Sensitivity analyses confirmed the robustness of the model.Conclusion Under the threshold of 3 times the GDP per capita in China,deucravacitinib is cost-effective in the treatment of moderate to severe plaque psoriasis.

BACKGROUND:Understanding the characteristics and influencing factors of the gut microbiota in athletes can help determine the optimal gut microbial composition for relevant sport events.Further investigation in this area could provide important insights for improving athletic performance and recovery as well as developing personalized nutrition prescriptions.OBJECTIVE:To summarize the characteristics of gut microbiota in athletes,and to elucidate the important factors influencing the gut microbiota characteristics of athletes from the perspectives of exercise training and dietary intake.METHODS:A literature search was conducted using the PubMed,ScienceDirect,CNKI,WanFang and VIP databases for publications from 2004 to 2024.The search terms included"microbiota,microbiome,athlete,exercise,training,diet,nutrition,dietary fiber,protein,ketogenic,fat"in English and Chinese.After excluding studies of poor quality and irrelevant content,a total of 65 articles were included for review and analysis.RESULTS AND CONCLUSION:(1)The gut microbiota of elite athletes differs from that of the general population,characterized by increased α-diversity,elevated Firmicutes/Bacteroidetes ratio,increased abundance of beneficial bacteria,and enrichment of functional pathways contributing to athletic performance.(2)The type of sport and training load are closely related to the species structure and functional expression of the gut microbiota in athletes.(3)The bidirectional communication between the host and gut microbiota mediated by metabolites is an important mechanism by which exercise influences the gut microbiota.(4)Phase training typically induces adaptive changes in the gut microbiota,and alterations in the structure or function of the microbiota have lasting effects.(5)The type,quantity,and combination of macronutrients intake can significantly influence the structure and function of the gut microbiota,and interact synergistically or antagonistically with exercise training.(6)In the future,it is important to continue the exploration of the gut microbiota in athletes,clarify causal relationships,and establish new targets for exercise training interventions.

Objective:To evaluate the clinical utility of machine learning model based radiomics in predicting high-risk molecular subtypes of lower-grade gliomas(LrGGs).Methods:This was a cross-sectional study. A total of 287 patients diagnosed with LrGGs in the First Hospital of Shanxi Medical University, Shanxi Provincial People′s Hospital, and the Third Hospital of Shanxi Medical University from January 2011 to September 2023 were retrospectively collected, including 166 males and 121 females; 114 cases of high-risk molecular subtypes and 173 cases of non-high-risk molecular subtypes. All patients were divided into 201 cases in the training set and 86 cases in the test set according to 7∶3 in simple randomized grouping method. All patients underwent contrast-enhanced T 1WI (CE-T 1WI) and T 2-weighted fluid-attenuated inversion recovery sequence imaging (T 2-FLAIR), and the imaging features of high-risk and non-high-risk molecular subtypes were analyzed. Analysis of variance, recursive feature elimination, and Kruskal-Wallis were used for radiomics feature screening, and a support vector machine (SVM) classifier was used to construct a radiomics-based classifier model. Univariate and multivariate logistic regression were used to analyze clinical variables independently influencing high-risk molecular subtypes of LrGGs to construct a clinical model; a combined model was developed by integrating radiomics labels and clinical variables. Receiver operating characteristic curve and area under the curve (AUC), calibration curve, and decision curve were used to compare the predictive performance of different models. Results:The patient′s age ( OR=1.042, 95% CI 1.018-1.068, P=0.001), pathological grade ( OR=2.270, 95% CI 1.212-4.311, P=0.011), MGMT methylation status ( OR=0.456, 95% CI 0.238-0.866, P=0.017), and ependymal involvement ( OR=7.335, 95% CI 2.929-18.370, P<0.001) were independent influencing factors for the high-risk molecular subtype of LrGGs, and a clinical model was developed based on these factors. An SVM model was constructed based on 12 radiomics features (3 radiomics features based on CE-T 1WI and 9 radiomics features based on T 2-FLAIR). The radiomics score of the probability output by the SVM model was combined with age, pathological grade, MGMT methylation status, and ependymal involvement to develop a combined model. The AUC values of the SVM model for predicting the high-risk molecular subtype of LrGGs were 0.824 and 0.859 in the training set and test set, respectively; the AUC values of the clinical model in the training set and test set were 0.759 and 0.721, respectively; and the AUC values of the combined model in the training set and test set were 0.823 and 0.815, respectively. The combined model had a high clinical net benefit. Conclusion:The machine learning MRI radiomics model can preoperatively predict high risk molecular subtypes of LGGrs, assist in individualized treatment decisions.

Objective:We aimed to develop a nomogram in corporating multidetector computed tomography(MDCT)imaging features and clinicopathological indicators for the preoperative prediction of axillary lymph node metastasis(ALNM)in patients with triple-negative breast cancer(TNBC).Methods:We retrospectively analyzed data from 265 female patients with pathologically confirmed TNBC treated at Harbin Medical University Cancer Hospital between November 2020 and October 2024.Patients were randomly assigned into a training cohort(n=161)and a validation cohort(n=104)in a 6:4 ratio.Feature selection was performed using least absolute shrinkage and selection operator(LASSO)regression with 10-fold cross-validation.Independent predictors of ALNM were identified by multivariate Logistic regression analysis,and a nomogram was constructed accordingly.Model performance was assessed using receiver operating characteristic(ROC)curves,calib-ration plots,and decision curve analysis(DCA).Results:Three independent predictors of ALNM were identified:clinical N-stage(odds ratio[OR]=6.789;95%confidence interval[CI]:2.203-22.20;P=0.001),short-axis diameter of lymph nodes on CT(OR=1.686;95%CI:1.349-2.257;P<0.001),and cortical thickness(OR=6.296;95%CI:2.170-19.310;P=0.001).The nomogram showed strong discrimination,with areas under the ROC curve(AUC)of 0.918(95%CI:0.860-0.977)in the training cohort and 0.885(95%CI:0.809-0.962)in the validation cohort.Calibration was confirmed by Hosmer-Lemeshow tests(P=0.609 and P=0.694 for training and validation cohorts,respectively).DCA demon-strated clinical utility across probability thresholds of 0.02-0.96 and 0.03-0.87 in the training and validation cohorts,respectively.Conclu-sions:This nomogram,integrating MDCT imaging features and clinical indicators,provides a practical tool for individualized preoperative risk assessment and may aid clinical decision-making in patients with TNBC.