1.Three-party game and simulation analysis of health-related information quality regu-lation in public health emergencies
Yu WANG ; Rui YUAN ; Shupeng LI ; Chun CHANG
Journal of Peking University(Health Sciences) 2025;57(3):514-521
Objective:To construct a tripartite game model involving the government,the public,and the pharmaceutical industry alliance during public health emergencies,revealing the dynamic mechanisms of health-related information quality regulation and exploring effective strategies to optimize the informa-tion dissemination environment through reward-punishment mechanisms.Methods:Based on evolutionary game theory,a tripartite evolutionary game model was established,integrating strategy spaces,payoff functions,and parameter definitions for each stakeholder.The pharmaceutical industry alliance's strate-gies included publishing high-or low-quality information(α),the public's strategies encompassed ration-al analysis or passive response(β),and the government's strategies involved regulatory enforcement or inaction(γ).Key parameters,such as economic benefits(Iyy),regulatory costs(Czf),penalties(Fyy),and incentives(Pyy),were quantified to reflect real-world scenarios.Replicator dynamic equa-tions and Jacobian matrices were derived to analyze the stability of equilibrium points,while MATLAB 2016a simulations were conducted to validate the model under varying initial conditions(e.g.,Iyy=100,150,200;Pyy=0,20,35;Fyy=0,10,20).Sensitivity analyses examined the impact of critical pa-rameters on system evolution,by 50 iterative simulations to observe convergence patterns.Results:The study revealed three key findings:(1)Public rational discernment(β)significantly influenced the phar-maceutical industry's strategy.Simulations demonstrated that increasing Iqz(benefits of information acqui-sition)reduced Cqz(cognitive costs),elevating β from 0.4 to 0.8 and driving α(high-quality information probability)to stabilize at 1.(2)Government regulatory intensity(γ)correlated positively with the so-cial hazards of low-quality information.When Fyy+Pyy>Iyy,speculative behaviors decreased,achieving equilibrium at α=1.(3)Dual stable equilibria emerged:a high-quality equilibrium(α=1,β=1,γ=0)with lower regulatory costs and a low-quality equilibrium(α=0,β=0,γ=1)associated with higher social risks.Phase diagrams illustrated path dependency,where initial α<0.5 led to the low-quality equilibrium unless dynamic penalties(Fyy>20)and incentives(Pyy>30)were enforced.Conclusion:A"carrot-stick"collaborative governance framework is proposed,emphasizing categorized regulation,AI-enabled auditing,and dynamic penalty systems.Future research should integrate emotional utility func-tions to address irrational decision-making impacts,thereby enhancing the adaptability of health informa-tion regulatory systems.
2.Radionuclide Drug Conjugates:China's 15-Year Research and Development Process and Latest Policy Support
Dan LIU ; Xiuqi LI ; Shupeng LIU ; Xiaofei WU ; Mengyang YU ; Hongyun WANG
Medical Journal of Peking Union Medical College Hospital 2025;16(4):847-854
Radionuclide drug conjugates(RDC)represent the culmination of interdisciplinary integra-tion.By virtue of their precise targeting capability,high diagnostic sensitivity,and remarkable therapeutic effi-cacy in tumor diagnosis and treatment,RDC has emerged as promising theranostic agents with immense applica-tion potential.This article systematically reviews the progress in RDC development in China from 2009 to 2024,encompassing an overview of RDC,its structure and classification,trends in clinical research,advances in clinical trials,and national policy support.The aim is to provide valuable insights for researchers in related fields,thereby facilitating further development and application of RDC-based therapeutics.
3.Radionuclide Drug Conjugates:China's 15-Year Research and Development Process and Latest Policy Support
Dan LIU ; Xiuqi LI ; Shupeng LIU ; Xiaofei WU ; Mengyang YU ; Hongyun WANG
Medical Journal of Peking Union Medical College Hospital 2025;16(4):847-854
Radionuclide drug conjugates(RDC)represent the culmination of interdisciplinary integra-tion.By virtue of their precise targeting capability,high diagnostic sensitivity,and remarkable therapeutic effi-cacy in tumor diagnosis and treatment,RDC has emerged as promising theranostic agents with immense applica-tion potential.This article systematically reviews the progress in RDC development in China from 2009 to 2024,encompassing an overview of RDC,its structure and classification,trends in clinical research,advances in clinical trials,and national policy support.The aim is to provide valuable insights for researchers in related fields,thereby facilitating further development and application of RDC-based therapeutics.
4.Three-party game and simulation analysis of health-related information quality regu-lation in public health emergencies
Yu WANG ; Rui YUAN ; Shupeng LI ; Chun CHANG
Journal of Peking University(Health Sciences) 2025;57(3):514-521
Objective:To construct a tripartite game model involving the government,the public,and the pharmaceutical industry alliance during public health emergencies,revealing the dynamic mechanisms of health-related information quality regulation and exploring effective strategies to optimize the informa-tion dissemination environment through reward-punishment mechanisms.Methods:Based on evolutionary game theory,a tripartite evolutionary game model was established,integrating strategy spaces,payoff functions,and parameter definitions for each stakeholder.The pharmaceutical industry alliance's strate-gies included publishing high-or low-quality information(α),the public's strategies encompassed ration-al analysis or passive response(β),and the government's strategies involved regulatory enforcement or inaction(γ).Key parameters,such as economic benefits(Iyy),regulatory costs(Czf),penalties(Fyy),and incentives(Pyy),were quantified to reflect real-world scenarios.Replicator dynamic equa-tions and Jacobian matrices were derived to analyze the stability of equilibrium points,while MATLAB 2016a simulations were conducted to validate the model under varying initial conditions(e.g.,Iyy=100,150,200;Pyy=0,20,35;Fyy=0,10,20).Sensitivity analyses examined the impact of critical pa-rameters on system evolution,by 50 iterative simulations to observe convergence patterns.Results:The study revealed three key findings:(1)Public rational discernment(β)significantly influenced the phar-maceutical industry's strategy.Simulations demonstrated that increasing Iqz(benefits of information acqui-sition)reduced Cqz(cognitive costs),elevating β from 0.4 to 0.8 and driving α(high-quality information probability)to stabilize at 1.(2)Government regulatory intensity(γ)correlated positively with the so-cial hazards of low-quality information.When Fyy+Pyy>Iyy,speculative behaviors decreased,achieving equilibrium at α=1.(3)Dual stable equilibria emerged:a high-quality equilibrium(α=1,β=1,γ=0)with lower regulatory costs and a low-quality equilibrium(α=0,β=0,γ=1)associated with higher social risks.Phase diagrams illustrated path dependency,where initial α<0.5 led to the low-quality equilibrium unless dynamic penalties(Fyy>20)and incentives(Pyy>30)were enforced.Conclusion:A"carrot-stick"collaborative governance framework is proposed,emphasizing categorized regulation,AI-enabled auditing,and dynamic penalty systems.Future research should integrate emotional utility func-tions to address irrational decision-making impacts,thereby enhancing the adaptability of health informa-tion regulatory systems.
5.Clinical Landscape of Therapeutic Cancer Vaccines: Challenges and Opportunities
Shupeng LIU ; Mengyang YU ; Xiaofei WU ; Hongyun WANG
Medical Journal of Peking Union Medical College Hospital 2024;15(6):1356-1363
To explore the status and characteristics of clinical trials of therapeutic cancer vaccines, and provide the overall trend of clinical translational research of therapeutic cancer vaccines. The ClinicalTrial registration platform was employed to retrieve relevant clinical trial information of therapeutic cancer vaccines from 2002 to 2023. The current clinical landscape of therapeutic cancer vaccines was analyzed from the perspectives of the number of registrations, types of vaccines, trial design, and geographical distribution. A total of 1563 clinical trials for therapeutic cancer vaccines were obtained from 2002 to 2023, with an average annual registration of approximately 70 trials. Among these, phase Ⅰ trials accounted for 976 (62.4%, 976/1563), phase Ⅱ trials for 474 (30.3%, 474/1563), phase Ⅲ trials for 68 (4.4%, 68/1563), and other types for 45 (2.9%, 45/1563). Clinical trials from phase Ⅰ to phase Ⅲ were conducted in multiple regions worldwide, with multicenter clinical trials totaling 482 (31.8%) and single-center clinical trials totaling 1036 (68.2%). The main types of vaccines were cell vector vaccines (38.7%, 588/1518) and protein/peptide vaccines (34.1%, 518/1518), with the primary research designs being single-arm studies (55.3%, 840/1518) and randomized controlled trials (27.8%, 422/1518). The top five indications for the vaccines were melanoma (16.5%, 251/1518), glioblastoma (8.9%, 135/1518), breast cancer (8.6%, 130/1518), prostate cancer (8.5%, 129/1518), and lung cancer (8.1%, 123/1518). The overall development of clinical trials for therapeutic cancer vaccines has been stable and primarily focused on exploratory trials. The main types of vaccines were cell vector vaccines, and the main research designs were single-arm studies and randomized controlled trials. The vaccines were commonly indicated for melanoma, glioblastoma, and breast cancer. Currently, there are significant challenges in the clinical translation in this field, which may be due to the complexity of the immune microenvironment, patient heterogeneity, and the challenges in vaccine design and preparation. With the application of high-throughput technologies such as proteomics, genomic sequencing, and bioinformatics, it is expected that barriers in the research of therapeutic cancer vaccines would be overcome, thus leading to a better clinical translation landscape.
6.Clinical Landscape of Therapeutic Cancer Vaccines: Challenges and Opportunities
Shupeng LIU ; Mengyang YU ; Xiaofei WU ; Hongyun WANG
Medical Journal of Peking Union Medical College Hospital 2024;15(6):1356-1363
To explore the status and characteristics of clinical trials of therapeutic cancer vaccines, and provide the overall trend of clinical translational research of therapeutic cancer vaccines. The ClinicalTrial registration platform was employed to retrieve relevant clinical trial information of therapeutic cancer vaccines from 2002 to 2023. The current clinical landscape of therapeutic cancer vaccines was analyzed from the perspectives of the number of registrations, types of vaccines, trial design, and geographical distribution. A total of 1563 clinical trials for therapeutic cancer vaccines were obtained from 2002 to 2023, with an average annual registration of approximately 70 trials. Among these, phase Ⅰ trials accounted for 976 (62.4%, 976/1563), phase Ⅱ trials for 474 (30.3%, 474/1563), phase Ⅲ trials for 68 (4.4%, 68/1563), and other types for 45 (2.9%, 45/1563). Clinical trials from phase Ⅰ to phase Ⅲ were conducted in multiple regions worldwide, with multicenter clinical trials totaling 482 (31.8%) and single-center clinical trials totaling 1036 (68.2%). The main types of vaccines were cell vector vaccines (38.7%, 588/1518) and protein/peptide vaccines (34.1%, 518/1518), with the primary research designs being single-arm studies (55.3%, 840/1518) and randomized controlled trials (27.8%, 422/1518). The top five indications for the vaccines were melanoma (16.5%, 251/1518), glioblastoma (8.9%, 135/1518), breast cancer (8.6%, 130/1518), prostate cancer (8.5%, 129/1518), and lung cancer (8.1%, 123/1518). The overall development of clinical trials for therapeutic cancer vaccines has been stable and primarily focused on exploratory trials. The main types of vaccines were cell vector vaccines, and the main research designs were single-arm studies and randomized controlled trials. The vaccines were commonly indicated for melanoma, glioblastoma, and breast cancer. Currently, there are significant challenges in the clinical translation in this field, which may be due to the complexity of the immune microenvironment, patient heterogeneity, and the challenges in vaccine design and preparation. With the application of high-throughput technologies such as proteomics, genomic sequencing, and bioinformatics, it is expected that barriers in the research of therapeutic cancer vaccines would be overcome, thus leading to a better clinical translation landscape.
7.99mTc-3PRGD2 SPECT/CT Imaging for Diagnosing LymphNode Metastasis of Primary Malignant Lung Tumors
Liming XIAO ; Shupeng YU ; Weina XU ; Yishan SUN ; Jun XIN
Korean Journal of Radiology 2023;24(11):1142-1150
Objective:
To evaluate 99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid ( 99mTc-3PRGD2) singlephoton emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms.
Materials and Methods:
We prospectively enrolled 26 patients with primary malignant lung tumors who underwent 99mTc-3PRGD2 SPECT/CT and 18F-fluorodeoxyglucose ( 18F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semiquantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and perpatient levels using histopathological results as the reference standard.
Results:
Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of 99mTc-3PRGD2 SPECT/CT and18F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC)in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT was 0.908 (95% confidence interval [CI], 0.851–0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641–0.974).
Conclusion
99mTc-3PRGD2 SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.
8.Incidence and treatment analysis of gastric cancer in Tianjin: a report of 3 122 cases
Xiaona WANG ; Weihua FU ; Yongjie ZHAO ; Tao YANG ; Xiangyang YU ; Junzhong SHI ; Guodong SONG ; Haotian LI ; Shupeng ZHANG ; Hai HUANG ; Jinfang ZHANG ; Jianping BAI ; Jinlin WANG ; Shucheng WANG ; Zhaokui DUAN ; Naihui SUN ; Tong LIU ; Han LIANG
Chinese Journal of Digestive Surgery 2023;22(10):1205-1211
Objective:To investigate the incidence and treatment of gastric cancer in 16 medical centers in Tianjin from 2020 to 2021.Methods:The retrospective and descriptive study was conducted. The clinical data of 3 122 gastric cancer patients who underwent surgery in 16 medical centers, including Tianjin Medical University Cancer Institute & Hospital, et al, in Tianjin from 2020 to 2021 were collected. There were 2 112 males and 1 010 females, aged (64±11)years. Observation indicators: (1) general data of patients; (2) treatment situations; (3) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted by the chi-square test. Results:(1) General data of patients. From 2020 to 2021, a total of 3 122 gastric cancer patients received surgeries in 16 medical centers in Tianjin, including 2 112 males and 1 010 females. There were 1 443 cases in 2020, including 976 males and 467 females, aged (63±11) years. There were 1 679 cases in 2021, including 1 136 males and 543 females, aged (65±11) years. Of the 3 122 pati-ents, cases in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 696, 667, 1 466, 293, accounting for 22.293%(696/3 122), 21.365%(667/3 122), 46.957%(1 466/3 122), 9.385%(293/3 122), respectively. Cases with early gastric cancer, locally advanced gastric cancer, advanced gastric cancer account for 17.265%(539/3 122), 73.350%(2 290/3 122), 9.385%(293/3 122). There were 2 829 patients without distant metastasis and 293 patients with distant metastasis. For the 2 829 patients without distant metas-tasis, cases in stage T1, T2, T3, T4a, T4b accounted for 19.053%(539/2 829), 12.089%(342/2 829), 20.148%(570/2 829), 41.499%(1 174/2 829), 7.211%(204/2 829)respectively, cases in stage N0, N1, N2, N3 account for 37.328%(1 056/2 829), 16.331%(462/2 829), 15.836%(448/2 829), 30.505%(863/2 829). For the 293 advanced gastric cancer patients with distant metastasis, 190 cases had peri-toneal metastasis, 47 cases had lymph node metastasis, 27 cases had ovarian metastasis, 37 cases had liver metastasis, 14 cases had other metastasis (some patients had ≥2 distant metastases). (2) Treatment situations. ① For the 539 with early gastric cancer, cases undergoing endoscopic submu-cosal dissection, laparoscopic surgery, open surgery were 22, 150, 86 in 2020, versus 19, 212, 50 in 2021, showing a significant difference between them ( χ2=19.42, P<0.05). For the 498 patients with early gastric cancer who underwent laparoscopic or open surgery, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 25, 81, 30, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrec-tomy were 18, 309, 35, respectively, showing a significant difference between them ( χ2=40.62, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery and laparoscopic surgery were 446 and 617 in 2020, versus 410 and 817 in 2021, showing a significant difference between them ( χ2=17.75, P<0.05). For the 2 290 patients with locally advanced gastric cancer, cases undergoing open surgery including total gastrectomy, distal gastrectomy, proxi-mal gastrectomy were 336, 377, 143, and cases undergoing laparoscopic surgery including total gastrectomy, distal gastrectomy, proximal gastrectomy were 377, 920, 137, respectively, showing a significant difference between them ( χ2=89.64, P<0.05). Of the 293 patients with advanced gastric cancer, 175 cases underwent surgeries due to hemorrhage, stenosis, perforation, 76 cases under-went surgery after chemotherapy, 42 cases underwent surgery directly. ② For 756 cases of 3 122 pati-ents undergoing total gastrectomy, 357 and 4 cases received open digestive tract reconstruction including Roux-en-Y and other anastomosis, versus 380 and 15 cases with laparoscopic digestive tract reconstruction including Roux-en-Y and other anastomosis, showing a significant difference between them ( χ2=5.57, P<0.05). For 1 687 cases undergoing distal gastrectomy, 84, 160, 158, 55 cases received open digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, versus 154, 489, 417, 170 cases with laparoscopic digestive tract reconstruction including Billroth Ⅰ anastomosis, Billroth Ⅱ + Braun anastomosis, Roux-en-Y anastomosis, uncut Roux-en-Y anastomosis, showing a significant difference between them ( χ2=10.90, P<0.05) . Of the 539 patients with early gastric cancer, 65 cases had lymph node metastasis, in which 18 of 306 stage T1a cases had lymph node metastasis and 47 of 233 stage T1b cases had lymph node metastasis. The number of detected lymph nodes for the 2 290 patients with advanced gastric cancer was 31±15, including ≥16 for 2 059 cases and ≥30 for 1 276 cases. Of the 3 122 patients, cases with neoadjuvant therapy, complete response and incomplete response was 128, 13 and 115 in 2020, versus 250, 49 and 201 in 2021, showing a significant difference between them ( χ2=5.51, P<0.05). (3) Postoperative complications. Of the 3 122 patients, 746 cases had postoperative complications, with an incidence of 23.895%(746/3 122). There were 62 patients with grade 3 or more complications. Reoperation was conducted in 34 patients. There were 14 cases of postoperative death. The duration of postoperative hospital stay and hospital expense were (11±5)days and (98 114±46 598)yuan for the 3 122 patients, (26±14)days and (122 066±68 317)yuan for cases with complications, (40±21)days and (196 926±12 747)yuan for cases with grade 3 or more complications. Conclusion:Compared with 2020, cases undergoing laparoscopic surgery and distal gastrectomy for gastric cancer in Tianjin increases in 2021, and the digestive tract reconstruction also differs. The number of patients with neoadjuvant chemotherapy and complete response rate for advanced gastric cancer increases.
9.Effect of botulinum toxin type A on flap surgery in animal models: a systematic review and meta-analysis
Shupeng SHI ; Lujing FEI ; Tao LIN ; Qiang WANG ; Hong FANG ; Gang YU ; Liping ZHAO
Chinese Journal of Plastic Surgery 2023;39(5):502-513
Objective:To evaluate the effect of botulinum toxin type A (BTXA) on flap surgery in animal models.Methods:Nine databases (PubMed, Cochrane Library, Ovid, Web of Science, Embase, Scopus, CBM, CNKI, and WANFANG database) were searched for published literature comparing the effects of BTXA (BTXA group) versus saline or no treatment (control group) on flap operation in animal models from January 1979 to March 2022. The literature was screened according to inclusion and exclusion criteria. Indicators included flap survival rate, blood flow and vascular endothelial growth factor (VEGF) expression level after surgery. The subjects were divided into pre-operation injection group and intraoperation injection group according to the intervention timing, and were divided into random flap group and axial flap group according to the type of flaps, and subgroup analysis was conducted respectively. Review Manager (RevMan) 5.3 software and Stata 15.1 software were used for all statistical analysis.Results:A total of 603 animals from 19 studies were included after rigorous inclusion and exclusion screening. Compared with control group, BTXA group revealed a significantly higher flap survival rate [mean difference ( MD)=15.65%, 95% CI: 13.11%-18.19%, Z=12.08, P<0.001], blood flow [standardized mean difference ( SMD)=1.96, 95% CI: 1.39-2.54, Z=6.71, P<0.001] and VEGF expression (at mRNA level: SMD=6.01, 95% CI: 0.89-11.13, Z=2.30, P=0.020; at protein level: SMD=3.44, 95% CI: 2.44-4.43, Z=6.73, P<0.001). Subgroup analysis showed that the flap survival rate of the pre-operation injection group ( MD=21.54%, 95% CI: 16.07%-27.01%, Z=7.71, P<0.001) was significantly higher than that of the intraoperative injection group ( MD=9.40%, 95% CI: 6.79%-12.00%, Z=7.07, P<0.001). The flap survival rate of the random flap group ( MD=20.87%, 95% CI: 16.67%-25.07%, Z=9.73, P<0.001) was significantly higher than that of the axial flap group ( MD=13.11%, 95% CI: 8.91%-17.31%, Z=6.12, P<0.001). Conclusion:BTXA assisted flap surgery may have positive effects on the survival rate, blood flow and VEGF expression in animal models. In addition, injection timing and flap type may also be important factors in the effect of BTXA on flap surgery.
10.Effect of botulinum toxin type A on flap surgery in animal models: a systematic review and meta-analysis
Shupeng SHI ; Lujing FEI ; Tao LIN ; Qiang WANG ; Hong FANG ; Gang YU ; Liping ZHAO
Chinese Journal of Plastic Surgery 2023;39(5):502-513
Objective:To evaluate the effect of botulinum toxin type A (BTXA) on flap surgery in animal models.Methods:Nine databases (PubMed, Cochrane Library, Ovid, Web of Science, Embase, Scopus, CBM, CNKI, and WANFANG database) were searched for published literature comparing the effects of BTXA (BTXA group) versus saline or no treatment (control group) on flap operation in animal models from January 1979 to March 2022. The literature was screened according to inclusion and exclusion criteria. Indicators included flap survival rate, blood flow and vascular endothelial growth factor (VEGF) expression level after surgery. The subjects were divided into pre-operation injection group and intraoperation injection group according to the intervention timing, and were divided into random flap group and axial flap group according to the type of flaps, and subgroup analysis was conducted respectively. Review Manager (RevMan) 5.3 software and Stata 15.1 software were used for all statistical analysis.Results:A total of 603 animals from 19 studies were included after rigorous inclusion and exclusion screening. Compared with control group, BTXA group revealed a significantly higher flap survival rate [mean difference ( MD)=15.65%, 95% CI: 13.11%-18.19%, Z=12.08, P<0.001], blood flow [standardized mean difference ( SMD)=1.96, 95% CI: 1.39-2.54, Z=6.71, P<0.001] and VEGF expression (at mRNA level: SMD=6.01, 95% CI: 0.89-11.13, Z=2.30, P=0.020; at protein level: SMD=3.44, 95% CI: 2.44-4.43, Z=6.73, P<0.001). Subgroup analysis showed that the flap survival rate of the pre-operation injection group ( MD=21.54%, 95% CI: 16.07%-27.01%, Z=7.71, P<0.001) was significantly higher than that of the intraoperative injection group ( MD=9.40%, 95% CI: 6.79%-12.00%, Z=7.07, P<0.001). The flap survival rate of the random flap group ( MD=20.87%, 95% CI: 16.67%-25.07%, Z=9.73, P<0.001) was significantly higher than that of the axial flap group ( MD=13.11%, 95% CI: 8.91%-17.31%, Z=6.12, P<0.001). Conclusion:BTXA assisted flap surgery may have positive effects on the survival rate, blood flow and VEGF expression in animal models. In addition, injection timing and flap type may also be important factors in the effect of BTXA on flap surgery.

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