Objective To compare and analyze the changes in the use of lung cancer therapeutic drugs before and after the national initiation of health insurance negotiations, and to study the impact of a series of policies on the use of lung cancer drugs. Methods Descriptive statistical methods were used analyze the basic situation of lung cancer patients and the changes of corresponding therapeutic drugs in Peking University People's Hospital from 2014 to 2020, as well as to the hospital procurement data of lung cancer therapeutic drugs in the database of the Chinese Medicine Economic Information. Results From 2014 to 2020, the total cost per capita of lung cancer patients showed a trend of first increasing and then decreasing, increasing before the national drug negotiation and gradually decreasing after the negotiation. After 2017, the use of small ATC categories such as VEGF/VEGFR inhibitors and EGFR tyrosine kinase inhibitors increased significantly, along with a rise in the number of monoclonal antibody varieties. The DDDs of osimertinib, anlotinib, alectinib, crizotinib and other drugs in the medical insurance list increased significantly, and the average daily cost decreased significantly. Conclusion The number of hospitalization days for lung cancer patients had continued to shorten in recent years, and the structure of drug use had changed significantly. The adjustment of the medical insurance catalog had led to more innovative lung cancer drugs showing the trend of volume up and price down.

Objective:To investigate the CT image characteristics of anterior ethmoidal artery（AEA） through CT scan and its significance in nasal endoscopic surgery. Methods:A retrospective study of 82 patients（164 sides） with chronic sinusitis was conducted. All patients underwent CT scan and the images were reconstructed. The AEA classification was used and calculate the rate of AEA suspension. The AEA was classified, and the suspension rate of the AEA was calculated. The height of the lateral lamella of the cribriform plate （LLCP） was measured, and Keros classification was performed. The relationship between Keros classification and AEA suspension was analyzed. The supraorbital ethmoidal cell （SOEC） was identified, and its relationship with AEA suspension was analyzed. Results:Type Ⅰ AEA accounted for 42.07%（69/164）. Type Ⅱ AEA accounted for 22.56%（37/164）. Type Ⅲ AEA accounted for 35.37%（58/164）. The suspension rate was 35.37%. The average height of the LLCP was （3.7±1.8） mm. In the Keros classification, type Ⅰaccounted for 53.05%（87/164）, Type Ⅱaccounted for 37.80%（62/164）. Type Ⅲ accounted for 9.15%（15/164）. The results of the Spearman analysis showed that there was a moderate positive correlation between the Keros classification and the suspension of the AEA（r=0.526, P<0.01）. Among 164 sides, SOEC was present in 15 sides. The suspension rate of AEA in the group with SOEC was significantly higher than that in the group without SOEC（P<0.01）. Conclusion:Sinus CT and multiplanar reconstruction can clarify the image characteristics of AEA and its relationship with surrounding structures. When the level of Keros classification is higher or SOEC is present, the suspension rate of AEA increases significantly. It is of great significance to clarify the characteristics of AEA before surgery in order to avoid injury during surgery.
Humans ; Retrospective Studies ; Endoscopy ; Ethmoid Sinus/diagnostic imaging* ; Tomography, X-Ray Computed ; Arteries/diagnostic imaging* ; Sinusitis/diagnostic imaging* ; Male ; Female ; Middle Aged ; Adult ; Aged

The RET protein encoded by RET proto-oncogene is a receptor tyrosine kinase that serves as a potential therapeutic target in non-small cell lung cancer (NSCLC) . In NSCLC, the incidence of RET fusions variants ranges from 1%-2% and is more common in younger, non-smoking patients. Traditional chemotherapy, immunotherapy, and multitarget kinase inhibitors have shown limited efficacy in treating RET fusion-positive NSCLC patients. However, selective RET inhibitors, such as selpercatinib and pralsetinib, have significantly improved the prognosis of those patients. The treatment strategy following resistance to selective RET inhibitors is a future research direction.

In recent decades,the incidence of human papillomavirus(HPV)-associated oropharyngeal squamous cell carcinoma(OPSCC)has shown a marked increase.Significant changes have also occurred in the OPSCC diagnosis and treatment paradigm.Deter-mining HPV status prior to treatment is now essential,and radiotherapy/chemotherapy,immunotherapy,and minimally invasive surgical techniques have progressively emerged as key modalities for managing OPSCC.However,alongside these paradigm shifts,a comprehen-sive technical consensus guiding the entire diagnostic and therapeutic process for OPSCC patients is currently lacking.Given China's large population base and the rising incidence of OPSCC,an expert panel convened to develop a clinical technical consensus on OPSCC diagno-sis and management tailored to China's specific context.This consensus aims to further enhance and standardize understanding of OPSCC management techniques among relevant healthcare professionals.

Objective:To analyze the association between remnant cholesterol (RC) and the risk of atherosclerotic cardiovascular disease (ASCVD) in community population in Shanghai.Methods:Using baseline and follow-up data from the Shanghai Suburban Adult Cohort and Biobank, individuals with ASCVD (including coronary heart disease, stroke, myocardial infarction, and peripheral artery disease) at baseline were excluded. A Cox proportional hazards regression model was employed to analyze the relationship between RC and ASCVD risk and the association under different LDL-C levels.Results:A total of 57 281 participants were included, with a median follow-up of 5.61 person-years. During the follow-up, 1 436 ASCVD events (2.51%) were recorded. After adjusting for potential confounders, individuals with moderate ( HR=1.18, 95% CI: 1.03-1.36) or high RC levels ( HR=1.32, 95% CI: 1.15-1.51) had an increased risk of ASCVD. The association was stronger in participants younger than 60 years-old (interaction P=0.048). Participants with RC ≥0.97 mmol/L and LDL-C <3.40 mmol/L demonstrated a 19% ( HR=1.19, 95% CI: 1.06-1.35) increased risk of ASCVD. When RC ≥0.97 mmol/L and LDL-C ≥3.40 mmol/L, ASCVD risk increased by 42% ( HR=1.42, 95% CI: 1.21-1.67). Conclusions:Elevated RC increases ASCVD risk, regardless of LDL-C levels. RC can serve as a valuable predictor and intervention target for ASCVD.

Objective:To evaluate the safety and efficacy of early precise lower limb weight-bearing functional rehabilitation after open reduction and internal fixation of ankle fractures.Methods:A restropective multi-center study was conducted to enroll the eligible 120 patients with malleolar fracture who received the same surgical treatment from March 2023 to December 2023 at the trauma centers in 7 tertiary hospitals according to the inclusion criteria. They were assigned into a study group ( n=60) for precise lower limb weight-bearing functional rehabilitation with the assistance of intelligent lower limb walking rehabilitation crutches and a control group ( n=60) for conventional weight-bearing functional rehabilitation which was gradually increased according to their own feelings under the protection of a walking boot. All the 60 patients in the study group completed their final follow-ups. They were 25 males and 35 females, with an age of (43.8±16.6) years and a body mass index of (25.3±2.3) kg/m 2. Only 51 patients in the control group completed their final follow-ups. They were 27 males and 24 females, with an age of (45.1±16.4) years and a body mass index of (24.7±2.3) kg/m 2. When their incisions healed and their sutures were removed 2 weeks after operation, the patients were guided to start lower limb weight-bearing functional rehabilitation, and exercises for foot and ankle joint mobility and lower limb muscles. The end point of follow-up was 12 weeks after operation. The 2 groups were compared in terms of the crutch-off rates, thigh circumferences, calf circumferences, dorsiflexions, plantarflexions, ankle swellings, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, and visual analog scale (VAS) pain scores at 6 and 12 weeks after operation. The complications were also recorded in the 2 groups. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). At 6 and 12 weeks after operation, the crutch-off rates [41.7% (25/60) and 100.0% (60/60)], dorsiflexions (69.3%±21.6% and 82.9%±26.3%) and AOFAS ankle-hindfoot scores [(68.5±7.6) points and (96.9±3.7) points] in the study group were significantly better than those in the control group [13.7% (7/51) and 39.2% (20/51), 61.5%±16.5% and 72.0%±14.3%, (61.9±9.3) points and (90.1±7.2) points] ( P<0.05). At 6 weeks after operation, the thigh circumference (97.4%±1.9%), calf circumference (97.3%±1.9%), and plantarflexion (76.6%±19.8%) in the study group were significantly higher than those in the control group (95.9%±2.5%, 94.6%±3.2%, and 63.9%±16.9%) ( P<0.05). There were no significant differences between the 2 groups in ankle swelling at 6 or 12 weeks after operation, or thigh or calf circumference, plantarflexion, or VAS pain score at 12 weeks after operation ( P>0.05). No wound complications, secondary fracture displacement, or loosening of internal fixation occurred in either group during the follow-up period. There were no cases of nonunion or delayed union. Conclusions:Early lower limb weight-bearing functional rehabilitation after open reduction and internal fixation of ankle fractures demonstrates good safety. Precise weight-bearing rehabilitation accelerates functional recovery of the ankle, enabling earlier return to normal daily activities.

Background and Aims:Laparoscopic cholecystectomy(LC)is a common surgical method for the treatment of gallbladder diseases.However,some patients experience symptoms such as dyspepsia after surgery,which can affect their quality of life.Compound azinomide enteric-coated tablets,a novel drug,may improve dyspeptic symptoms after LC.This study was conducted to explore the clinical efficacy of compound azinomide enteric-coated tablets in treating post-LC dyspepsia symptoms through a multicenter clinical trial.Methods:A multicenter,superior efficacy,open-label,parallel-controlled design was used.Patients with postoperative dyspepsia were enrolled in 7 centers between January 2023 and May 2024.Patients were randomly assigned to either the observation or control groups using a random number table.The observation group received compound azinomide enteric-coated tablets,while the control group was treated with a combination of oryzae pancreatin tablets and ursodeoxycholic acid tablets.Both groups were treated for 4 weeks.The primary endpoints included gastrointestinal symptom scores and quality of life scores assessed before and at 14 and 28 d after treatment.Additionally,the incidence of adverse reactions and cost-effectiveness ratio(CER)were compared between the groups.Results:A total of 303 patients were included,with 150 in the observation group and 153 in the control group.Baseline characteristics were balanced between the groups before treatment(all P>0.05).After treatment,the observation group showed significantly higher effective rates at 14 d and 28 d than the control group(44.7%vs.29.4%;98.0%vs.73.9%,both P<0.05).The observation group also had significantly lower symptom scores and quality of life scores at both 14 and 28 d,with a significantly higher improvement rate in symptom scores compared to the control group(all P<0.05).Further analysis of the improvement rate and treatment efficacy for individual symptoms revealed that,except for the 14-d improvement in abdominal pain/discomfort,the observation group showed better improvement in all other symptoms at 14 d and in all symptoms at 28 d compared to the control group(all P<0.05).No adverse reactions were observed in either group.The CER for the observation group was 283.78 yuan/efficacy rate at 14 d and 128.57 yuan/efficacy rate at 28 d,while the control group's CER was 729.93 yuan/efficacy rate at 14 d and 290.22 yuan/efficacy rate at 28 d.Conclusion:Compound azinomide enteric-coated tablets demonstrated good clinical efficacy in treating dyspepsia symptoms after LC with excellent safety and high cost-effectiveness.Despite some limitations,the results provide a new treatment option for dyspepsia after LC.Larger-scale randomized controlled trials are needed to validate this study's conclusions further.

Objective:To compare the clinical efficacy and effects on cognitive function of magnetic seizure therapy (MST) and modified electroconvulsive therapy (MECT) in the treatment of major depressive episode (MDE).Methods:From January 1, 2019 to December 31, 2021, 40 patients who met the MDE diagnostic criteria in the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) were selected in Shanghai Mental Health Center. Participants were randomly assigned to MECT therapy group (20 patients) and MST therapy group (20 patients) using the random number table method. Both groups received MECT or MST while using serotonin reuptake inhibitors (SSRIs), 3 times a week for 4 weeks. The 17-items Hamilton Depression Rating Scale (HAMD 17) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were performed before and after treatment. HAMD 17 reduction rate and effective rate were the main assessment indicators, while RBANS total score and factor scores were considered as the secondary assessment indicators. T-test was used to compare the reduction rate of HAMD 17 between the two groups, and corrected Chi-square test or Fisher′s exact probability method was used to compare the effective rate of treatment between the two groups. HAMD 17 scores and RBANS scores before and after treatment were compared using two-factor repeated measure ANOVA. Results:There were no significant differences in baseline HAMD 17 scores and RBANS scores between 2 groups( t=0.29, P=0.773; t=0.67, P=0.509). The treatment effective rate in the MECT group was 90% (18/20), and the average reduction rate of HAMD 17 was 67.9%. Meanwhile, the effective rate of MST group was 75% (15/20), and the average reduction rate of HAMD 17 was 60.9%. There was no significant difference in the reduction rate and effective rate of HAMD 17 between the two groups ( t=0.69, P=0.493; χ2=0.16, P=0.693). The total scores and factor scores of RBANS after treatment were lower than those before treatment, with statistical significance(total scores: F=19.29, P<0.001;immediate memory score: F=6.22, P=0.020; language function score: F=9.13, P=0.006;attention score: F=5.23, P=0.031;delayed memory score: F=35.90, P<0.001). There was no significant difference in the total scores and factor scores of RBANS before and after treatment in MST group(total scores: F=0.49, P=0.490;immediate memory score: F=2.25, P=0.147;language function score: F=1.22, P=0.280;attention score: F=0.23, P=0.640;delayed memory score: F=0.02, P=0.887). Conclusions:The efficacy of MST treatment and MECT treatment in treating MDE patients seems to be comparable. MDE patients receiving MST had less impact on cognitive function compared to those treated with MECT.

Objective To explore the effects of ultrasound-guided intercostal nerve block(INB)and thoracic paravertebral nerve block(TPVB)on the dosage of anesthetics and the efficacy of analgesia in video-assisted thoracoscopic lobectomy.Methods From October 2019 to October 2023,90 patients undergoing video-assisted thoracoscopic lobectomy at the People's Hospital of Tongling City,Anhui,were selected.They were divided into the INB group(42 cases)and the TPVB group(48 cases).The INB group received ultrasound-guided intercostal nerve block,while the TPVB group was administered ultrasound-guided thoracic paravertebral nerve block.The two groups were compared before anesthesia induction(T0),15 minutes of anesthesia(T1),30 minutes of anesthesia(T2),45 minutes of anesthesia(T3),and after extubation(T4),vita4 signs,anesthetic dosage,analgesic effect,pain stress index and adverse reactions.Results In the TPVB group,systolic blood pressure(SBP)of T1,T2,T3 and T4 were(115.88±9.29)mmHg,(113.58±9.72)mmHg,(117.33±9.17)mmHg and(121.15±10.51)mmHg,respectively;diastolic blood pressure(DBP)were(86.74±7.35)mmHg,(90.83±8.82)mmHg,(90.83±8.82)mmHg and(91.05±8.73)mmHg,respectively;Heart rate(HR)were(79.94±7.46)times/min,(81.97±7.28)times/min,(82.36±7.41)times/min and(85.83±8.32)times/min,respectively.Which were all higher than the INB group[(103.53±8.28)mmHg,(105.40±8.66)mmHg,(109.03±8.13)mmHg,(114.64±9.65)mmHg.(77.68±6.57)mmHg,(79.27±6.69)mmHg,(83.21±7.37)mmHg,(85.83±8.21)mmHg,(71.17±6.21)times/min,(75.18±6.47)times/min,(74.82±6.12)times/min and(79.35±7.12)times/min,respectively],there were statistical significance between the two groups(P＜0.05).Postoperatively,the TPVB group had lower 24-hour sufentanil consumption[(27.68±2.64)μg]and fewer presses of the analgesia pump[(5.16±0.38)times]compared to the INB group[(36.22±3.36)μg and(6.87±0.42)times,(P＜0.05)].Visual analogue scale(VAS)scores for pain at rest and during coughing at 2,24,and 48 hours in group TPVB were 2.44±0.27,3.55±0.42,2.81±0.34 and 3.36±0.23,4.13±0.33,3.80±0.25,respectively,which were also lower than the INB group(2.83±0.44,3.98±0.55,3.33±0.46 and 3.87±0.30,4.59±0.47,4.17±0.29,respectively)(P＜0.05).Levels of prostaglandin E2(PGE2)(1.53±0.28 μg/L),norepinephrine(NE)(362.25±33.85 ng/L),and cortisol(Cor)(278.72±25.13 ng/L)in the TPVB group were lower than those in the INB group(2.71±0.32 μg/L,425.67±38.37 ng/L,315.68±29.21 ng/L)(P＜0.05).Adverse reactions such as nausea and vomiting,and dizziness were less frequent in the TPVB group[1(2.1％),1(2.1％)]compared to the INB group[6(12.5％),5(10.4％)](P＜0.05).Conclusion Ultrasound-guided thoracic paravertebral nerve block is superior to intercostal nerve block in terms of anesthetic dosage and analgesic efficacy in video-assisted thoracoscopic lobectomy.

Background and Aims:Laparoscopic cholecystectomy(LC)is a common surgical method for the treatment of gallbladder diseases.However,some patients experience symptoms such as dyspepsia after surgery,which can affect their quality of life.Compound azinomide enteric-coated tablets,a novel drug,may improve dyspeptic symptoms after LC.This study was conducted to explore the clinical efficacy of compound azinomide enteric-coated tablets in treating post-LC dyspepsia symptoms through a multicenter clinical trial.Methods:A multicenter,superior efficacy,open-label,parallel-controlled design was used.Patients with postoperative dyspepsia were enrolled in 7 centers between January 2023 and May 2024.Patients were randomly assigned to either the observation or control groups using a random number table.The observation group received compound azinomide enteric-coated tablets,while the control group was treated with a combination of oryzae pancreatin tablets and ursodeoxycholic acid tablets.Both groups were treated for 4 weeks.The primary endpoints included gastrointestinal symptom scores and quality of life scores assessed before and at 14 and 28 d after treatment.Additionally,the incidence of adverse reactions and cost-effectiveness ratio(CER)were compared between the groups.Results:A total of 303 patients were included,with 150 in the observation group and 153 in the control group.Baseline characteristics were balanced between the groups before treatment(all P>0.05).After treatment,the observation group showed significantly higher effective rates at 14 d and 28 d than the control group(44.7%vs.29.4%;98.0%vs.73.9%,both P<0.05).The observation group also had significantly lower symptom scores and quality of life scores at both 14 and 28 d,with a significantly higher improvement rate in symptom scores compared to the control group(all P<0.05).Further analysis of the improvement rate and treatment efficacy for individual symptoms revealed that,except for the 14-d improvement in abdominal pain/discomfort,the observation group showed better improvement in all other symptoms at 14 d and in all symptoms at 28 d compared to the control group(all P<0.05).No adverse reactions were observed in either group.The CER for the observation group was 283.78 yuan/efficacy rate at 14 d and 128.57 yuan/efficacy rate at 28 d,while the control group's CER was 729.93 yuan/efficacy rate at 14 d and 290.22 yuan/efficacy rate at 28 d.Conclusion:Compound azinomide enteric-coated tablets demonstrated good clinical efficacy in treating dyspepsia symptoms after LC with excellent safety and high cost-effectiveness.Despite some limitations,the results provide a new treatment option for dyspepsia after LC.Larger-scale randomized controlled trials are needed to validate this study's conclusions further.