Objective To explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

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 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.

Sleep disorders are a serious global health problem influenced by neuropsychiatric disorders, diseases, environment, diet, and other factors. Recent studies have revealed that gut microbes (GM) are closely associated with sleep. Their metabolites regulate circadian rhythms, neurotransmitter systems, and other physiological processes through the gut-brain axis, influencing brain homeostasis and contributing to the pathogenesis of insomnia. Suanzaoren decoction (SZRD) is a classic and well-known traditional Chinese medicine (TCM) prescription for the treatment of insomnia. Modern pharmacological research indicates that SZRD can maintain intestinal microbial homeostasis, regulate microbial metabolites, and safeguard the intestinal immune barrier. This review elucidates the pathophysiological interplay between sleep disorders and GM and summarizes the progress of research on SZRD in treating insomnia via the “microbes-gut-brain axis” by regulating intestinal microecology. It is expected to broaden the clinical application of TCM in insomnia treatment and provide a theoretical foundation for pharmacological innovation of classic TCM prescriptions.

OBJECTIVE To statistically analyze and detect signals for the adverse drug reactions(ADRs)related to tigecycline based on the ADR spontaneous reporting system,so as to provide reference for the prevention of medi-cation risks of tigecycline.METHODS ADR reports of tigecycline were extracted from the ADR spontaneous repor-ting system of the hospital from Oct.2013 to Mar.2024.Statistical analysis was conducted by Microsoft Excel and Free Statistics 2.1.1.The data mining and analysis were performed using the reporting odds ratio(ROR),the proportional reporting ratio(PRR)and the composite criteria of UK Medicines and Healthcare products Regulato-ry Agency(MHRA).RESULTS Among the 574 ADR reports with tigecycline as the primarily suspected drug,elderly patients accounted for over 50％.The ADRs mainly occurred within one week after medication administra-tion,involving 12 organ systems and 57 adverse reaction signals.Through comprehensive analysis using three methods,20 positive risk signals related to tigecycline were identified,mainly affecting the gastrointestinal system,hepatobiliary system and hematological system.The top 5 frequent ADR signals were nausea,vomiting,diarrhea,thrombocytopenia and hyperbilirubinemia.According to the ROR method,the top five ranked ADR sig-nals were hyperbilirubinemia(ROR=330.55),hepatocellular injury(ROR=110.22),elevated amylase(ROR=78.90),cholestasis(ROR=73.32),and decreased fibrinogen(ROR=43.65).CONCLUSIONS The adverse reac-tions of tigecycline mainly occur during the initial stage of medication,and special caution is required when used in elderly patients.High-intensity risk signals for ADRs are hyperbilirubinemia,liver injury,and others related to hematological system and gastrointestinal system.Close monitoring of these ADRs and timely intervention are necessary during medication.

Objective: To explore the association between negative life events and smartphone addiction among middle school students, so as to provide theoretical support and practical guidance for prevention and intervention of smartphone addiction among middle school students. Methods: Using cluster sampling, 8 890 students were selected to survey from 27 junior high schools and 3 senior high schools in a district of Shenzhen in 2022 (baseline) and 2023 (followup). Data were collected through selfresigned questionnaires on basic information, the Smartphone Addiction Scale-Short Version, and the Adolescent Selfrating Life Events Checklist. Mixedeffects models were employed to analyze the association. Results: Compared to 2022, the punishment scores of middle school students in 2023 [1.00 (0.00, 6.00) and 1.00 (0.00, 6.00)] decreased (Z=4.27), while the scores of interpersonal stress, learning stress and adaptation [4.00(0.00, 8.00), 4.00(0.00, 8.00); 4.00(1.00, 8.00), 5.00(2.00, 9.00); 2.00 (0.00, 6.00), 3.00 (0.00, 7.00)] increased (Z=-3.04, -8.36, -6.80) (P<0.01). Mixedeffects models revealed a positive doseresponse relationship between negative life events and smartphone addiction (OR=1.08-1.17, P<0.01). Stepwise regression showed independent positive effects of interpersonal stress (OR=1.05), academic stress (OR=1.03), and adaptation stress (OR=1.11) on smartphone addiction (P<0.01). Subgroup analysis of nonaddicted students in 2022 confirmed persistent associations for academic stress (OR=1.03) and adaptation (OR=1.07) (P<0.01). Conclusion Negative life events exhibit a positive doseresponse relationship with smartphone addiction, particularly interpersonal stress, academic stress, and adaptationrelated events.

Objective: To explore the longitudinal association between only-child status and smartphone addiction among middle school students, so as to provide a basis for establishing family intervention measures for smartphone addiction in middle school students. Methods: In October 2022 and October 2023, a preliminary survey and follow-up were conducted among 8 759 middle and high school students from 30 schools in a district of Shenzhen. A self-designed questionnaire was used to determine whether the students were the only-child, and the Chinese Version of the Smartphone Addiction Scale-Short Version (C-SAS-SV) was utilized to assess the students smartphone addiction status. A multilevel mixed-effects model and subgroup analysis were applied to examine the association between only-child status and smartphone addiction among middle school students. Results: During 2022 to 2023, the prevalence of smartphone addiction in the cohort of middle school students increased from 24.1% to 25.2%. Compared with only-child, non-only child were more likely to be addicted to smartphones (adjusted model: OR =1.2, 95% CI =1.1-1.4) and also scored higher on smartphone addiction (adjusted model: β =0.9, 95% CI =0.2-1.5)( P <0.05). Subgroup analysis further revealed that compared to baseline, non-only child demonstrated an increased prevalence of smartphone addiction (adjusted model: OR = 1.2 , 95% CI =1.0-1.5) and higher addiction scores (adjusted model: β =0.8, 95% CI =0.2-1.5) after one year( P <0.05). Conclusions Non-only child face higher risk of smartphone addiction. Under the current population policy, it is crucial to address smartphone addiction among middle school students who is not only child.

Objective:To explore the interaction of IL-2,IL-6 factors and intestinal flora disorder in patients with rheumatoid arthritis complicated with interstitial lung disease(RA-ILD).Methods:A total of 100 RA patients diagnosed at Shijiazhuang People's Hospital from June 2021 to June 2022 were enrolled and divided into the RA-ILD group(with ILD,n=27)and RA-noILD group(with-out ILD,n=73)according to the results of pulmonary CT and clinical manifestations.Fecal samples were collected from all partici-pants,and intestinal flora levels were cultured and analyzed.Bacterial DNA was extracted from fecal samples,and the 16S rDNA gene was amplified by PCR to generate DGGE profiles of gut microbiota.The Shannon-Wiener index,evenness,and richness of intestinal bacteria were calculated.Cluster analysis was performed to compare structural differences in gut microbiota between the groups.Demo-graphic characteristics,clinical symptoms,laboratory parameters,and intestinal flora-related indicators were compared between the groups.Multivariate Logistic regression analysis was conducted to identify independent risk factors for ILD development in RA pa-tients.Spearman correlation analysis was used to evaluate relationships between serum IL-2,IL-6 levels and gut microbiota parame-ters.Cox proportional hazards regression analysis was performed to determine independent factors influencing disease progression in RA-ILD patients.Results:Smoking,age≥53.77 years old,anti-CCP antibody≥334.60 RU/ml,IL-6≥199.47 ng/ml,IL-2<3.10 ng/ml,richness<18.39,Shannon-Wiener index<2.88,Bifidobacterium<7.27 CFU/g,Bacteroides fragilis<7.75 CFU/g,Hmax<3.14 and flora uniformity<0.92 were independent factors affecting the occurrence of ILD in patients with RA.In patients with RA-ILD,serum IL-6 level was negatively correlated with richness,Shannon-Wiener index,Hmax and flora evenness,while serum IL-2 level was positively correlated with richness,Shannon-Wiener index,Hmax and flora evenness.Smoking,age,anti-CCP antibody,IL-6,IL-2,richness,Shannon-Wiener index,Bifidobacterium,Bacteroides fragilis,Hmax and flora uniformity were independent factors affecting the outcome of RA-ILD patients(P<0.05).Conclusion:Smoking,age,anti-CCP antibody,IL-6,IL-2,richness,Shannon-Wiener index,Bifido-bacterium,Bacteroides fragilis,Hmax and flora uniformity have significant diagnostic and prognostic value for RA-ILD.The changes of intestinal microbial community in patients with RA-ILD and the changes in the number and structure of intestinal bacteria may be one of the important factors of RA patients complicated with ILD.

OBJECTIVE To evaluate the efficacy,safety and economics of calcium channel modulators in the treatment of diabetic peripheral neuropathic pain(DPNP),and provide evidence-based evidence for clinical drug selection and decision-making.METHODS PubMed,Embase,Cochrane Library,CNKI,Wanfang data,VIP net,CBM and official websites of foreign health technology assessment(HTA)institutions were systematically searched to collect HTA reports,systematic review/meta-analyses,and pharmacoeconomic studies of pregabalin,gabapentin,crisugabalin,and mirogabalin for the treatment of DPNP.The timeframe for all searches was from the inception to June 2024.After data extraction and quality assessment,the results of the included studies were analyzed descriptively.RESULTS A total of 16 articles were included,involving 1 HTA report,7 systematic reviews/meta-analyses,and 8 pharmacoeconomic studies.No studies on crisugabalin were retrieved.Compared with placebo,both pregabalin and mirogabalin reduced end point pain scores and increased the proportion of patients with≥30%and/or≥50%reduction in pain scores.Pregabalin also improved patient global impression of change(PGIC).Gabapentin was similar to placebo in reducing end point pain scores and increasing the proportion of patients with≥30%and/or≥50%reduction in pain scores,but gabapentin improved PGIC of patients.Compared with pregabalin,mirogabalin was more effective in the treatment of pain.The safety of pregabalin and mirogabalin was similar,and compared with placebo,both pregabalin and mirogabalin increased the risk of common adverse reactions such as dizziness and somnolence.The safety of gabapentin was similar to placebo and duloxetine.Compared with duloxetine,pregabalin and gabapentin were not cost-effective.Compared with gabapentin,pregabalin was cost-effective.Mirogabalin was cost-effective,as compared with placebo and pregabalin.CONCLUSIONS Pregabalin and mirogabalin are effective in the treatment of DPNP,the efficacy of mirogabalin is better than pregabalin,and the safety is similar between them.The economic conclusions vary from country to country,pending a pharmacoeconomic study based on our population.