OBJECTIVE From the perspective of China’s healthcare system， to evaluate the cost-effectiveness of tislelizumab in patients with locally advanced or metastatic squamous or non-squamous non-small cell lung cancer （NSCLC） whose disease progresses or is intolerable after receiving platinum-containing dual chemotherapy in the past. METHODS Rationale-303 research data were used to construct a partitioned survival model. The model period was set to be 21 days and simulated to 120 months. Using quality-adjusted life year （QALY） as a health output index， the incremental cost-effectiveness ratio （ICER） was calculated by discounting cost and health output with a discount rate of 5%. Single-factor sensitivity analysis and probability sensitivity analysis were performed to verify the robustness of the basic analysis results. RESULTS Cost-utility analysis results showed that the ICER of tislelizumab group was 65 653.52 yuan/QALY， compared with docetaxel group. This means that the regimen of tislelizumab was more cost-effective than the docetaxel regimen when the willingness-to-pay threshold （WTP） was 3 times China’s gross domestic product （GDP） per capita in 2023 （268 200 yuan/QALY）. The results of single-factor sensitivity analysis showed that the three parameters that had a greater impact on ICER were the prices of tislelizumab， docetaxel and pemetrexed. The results of the probabilistic sensitivity analysis showed that the probabilities of the above two treatment regimens being cost-effective were both 50% when the WTP threshold was approximately 65 000 yuan/QALY. The probability of tislelizumab regimen being cost- effective was 100% when the WTP threshold was ≥134 000 yuan/QALY. CONCLUSIONS From the perspective of China’s healthcare system， when taking 3 times China’s GDP per capita in 2023 as the WTP threshold， tislelizumab is cost-effective for patients with locally advanced or metastatic squamous or non-squamous NSCLC after receiving platinum-containing dual chemotherapy in the past， compared with docetaxel.

BACKGROUND: The potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE. METHODS: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction. RESULTS: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively. CONCLUSIONS Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.
Humans ; Pulmonary Embolism/complications* ; Case-Control Studies ; Male ; Ventricular Dysfunction, Right/physiopathology* ; Female ; Middle Aged ; Aged ; Coronary Stenosis/complications* ; Logistic Models ; Adult

Objective To systematically search,evaluate,and summarize the evidence for risk management of breast and ovarian cancers in carriers of breast cancer susceptibility gene 1/2(BRCA1/2)mutations.Methods A systematic search was conducted in BMJ Best Practice,UpTo-Date,the National Guideline Clearinghouse(NGC),the National Institute for Health and Care Ex-cellence(NICE),the Scottish Intercollegiate Guidelines Network(SIGN),the Guidelines Interna-tional Network(GIN),the New Zealand Guidelines Group(NZGG),the Canadian Medical Associa-tion Infobase(CMA InfoBase),the Registered Nurses' Association of Ontario(RNAO),the National Comprehensive Cancer Network(NCCN),Cancer Care Ontario(CCO),the Medlive website,the American Society of Clinical Oncology(ASCO),the European Society for Medical Oncology(ESMO),the American Cancer Society(ACS),the American College of Obstetricians and Gynecologists(ACOG),the Joanna Briggs Institute(JBI),the Cochrane Library,PubMed,Web of Science,Em-base,CINAHL,ProQuest,ClinicalTrials.gov,China National Knowledge Infrastructure,Wanfang Data,VIP Database,and SinoMed for evidence related to risk management of breast and ovarian canc-ers in BRCA1/2 mutation carriers,including clinical decisions,guidelines,systematic reviews,expert consensus,and evidence summaries.The search period was from the inception of each database to September 20,2024.Results A total of 14 articles were included,comprising 1 clinical decision,8 guidelines,and 5 expert consensus documents.Based on five themes-risk assessment,risk moni-toring,risk-reducing surgery,pharmacologic prevention,and health guidance,a total of 24 pieces of evidence were summarized.Conclusion The evidence summarization process in this study is standardized,and the summarized evidence is relatively comprehensive.Healthcare professionals should comprehensively consider patients' individual characteristics,family history,personal prefer-ences,and the accessibility of healthcare resources to achieve effective prevention and control of he-reditary tumor risks.

Objective To explore the association between visceral adiposity index(VAI)and nonalcoholic fatty liver disease(NAFLD)in lean population and the predictive value of VAI.Methods A total of 2 576 healthy subjects,body mass index(BMI)＜24 kg/m2,from The Second Affiliated Hospital of Xi'an Jiaotong University from June 2020 to May 2021 were randomly included and divided into lean NAFLD(n=213)and healthy control group(n=2 363).According to the VAI quartiles,they were divided into Q1-Q4 groups from low to high.The differences in biochemical parameters and the prevalence of NAFLD were compared among groups.The correlation between VAI and lean NAFLD was analyzed with restricted cubic spline(RCS),and the predictive value of VAI was explored by Logistic regression and receiver operating characteristic(ROC)curve.Results A total of 2 576 participants were included,and the prevalence of lean NAFLD was 8.3％(213 cases).The mean age,male ratio,BMI and waist circumference(WC)from group Q1 to group Q4 were significantly increased in a dose-response relationship(all P＜0.001).Compared with those in group Q1,systolic blood pressure,diastolic blood pressure,white blood cell count,hemoglobin concentration,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transpeptidase,alkaline phosphatase,total cholesterol,triglyceride,low-density lipoprotein cholesterol,blood uric acid,and fasting blood glucose levels in groups Q2 to Q4 were significantly increased,while direct bilirubin and high-density lipoprotein cholesterol levels were gradually decreased(both P＜0.001).The prevalence rate of NAFLD in groups Q1-Q4 was 0.6％,3.3％,7.0％and 22.2％,respectively(P＜0.001).RCS showed that the risk of NAFLD in lean population rose significantly with the increase of VAI(P＜0.001),and there was a nonlinear relationship between them(P for nonlinear＜0.001).Logistic regression showed that after adjusting other confounding factors,the risk of lean NAFLD in groups Q2,Q3 and Q4 was still 2.926 times(95％CI:0.971-8.811),3.435 times(95％CI:1.154-10.230),and 5.920 times(95％CI:1.873-18.719)that Q1 group.ROC curve showed that VAI had a good predictive value for lean NAFLD,with area under the curve of 0.815,critical value of 1.532,diagnostic sensitivity of 77.9％and specificity of 72.8％,which were better than BMI and WC.Conclusion VAI is significantly associated with the risk of NAFLD in lean population,and thus has a good predictive value.It can be used for early screening and diagnosis of lean NAFLD.

Objective To observe the effect of combination of partial body weight support and functional electrical stimulation on lower limb motor function for stroke patients. Methods From January,2023 to February,2024,60 stroke patients from Rehabilitation Hospital of Chancheng District People's Hospital in Foshan City were randomly divided into control group(n=30)and observation group(n=30).The control group received routine rehabilitation,while the observation group received a combination of ce-lestial orbit system and functional electrical stimulation in addition,for three weeks.They were assessed with Balance assessment and training system,Berg Balance Scale(BBS),Fugl-Meyer Assessment-Lower Extremities(FMA-LE)and Holden Functional Ambulation Category(FAC)before and after treatment. Results X-axis trajectory length,average speed of swaying,total wobble trajectory,Y-axis trajectory length,trajectory length per unit area,BBS score,FMA-LE score and FAC score improved in both groups after treatment(|t|＞4.809,P＜0.001);and all the indexes improved more in the observation group than in the control group(|t|＞2.268,P＜0.05),except X-axis trajectory length and average speed of swaying. Conclusion Supplement of the combination of partial body weight support and functional electrical stimulation is more effective on lower limb motor function,balance and walking for stroke patients.

Dysregulation of transforming growth factor β （TGF- β） signaling pathway is related to the occurrence and development of various pathological conditions， including tumors. In the early stage of tumorigenesis， TGF- β， as an anti- proliferation and pro-differentiation factor， plays an anticancer role. In advanced tumors， TGF-β can stimulate tumor progression and metastasis through its effect on the tumor microenvironment （such as promoting angiogenesis， fibrosis， immune suppression， and regulating cellular metabolism）. A variety of TGF-β signaling pathway inhibitors have been tested in clinical trials， including monoclonal antibodies， ligand traps， small molecule inhibitors， antisense oligonucleotides， bispecial antibodies， and tumor vaccines， but no related drugs are currently approved for cancer treatment clinically. Accurately screening potential benefit patients and combining it with immune checkpoint inhibitors are its future development directions.

Objective:To construct a teaching ability evaluation system for diversified general medicine course teachers under the guidance of "one practice and three learning".Methods:A research group was established to search for relevant documents and literature. A framework of evaluation index system was established through drafting and repeated discussion and modification by members of the group, as well as further discuss and modification by experts in general medicine. The framework was used to develop an expert consultation questionnaire on the teaching ability evaluation system for diversified general medicine course teachers under the guidance of "one practice and three learning". Through two rounds of expert consultation, a teaching ability evaluation system for diversified general medicine teachers under the guidance of "one practice and three learning" was constructed. A questionnaire was developed according to the system. The rationality and scientificity of the evaluation index system were verified by questionnaire survey.Results:The teaching ability evaluation system for diversified general medicine teachers under the guidance of "one practice and three learning" included 3 first-level indicators, 15 second-level indicators, and 41 third-level indicators. The general medicine curriculum evaluation questionnaire developed on the system showed that the Cronbach's α coefficient of the overall evaluation system was 0.981. The Cronbach's α coefficients of first-level indicators, including general medicine teaching plan, diversified theory and practice teaching, and comprehensive ability cultivation under the guidance of "one practice and three learning" ideology, were 0.920, 0.919, and 0.923, respectively. The content validity index (S-CVI) of the system was 0.981, and the content validity index (I-CVI) of indicators were 0.826-1.000. The correlation coefficients of first-level indicators and the system were 0.837-0.942 (all P<0.05). The correlation coefficients of second-level indicators and their corresponding first-level indicators were 0.586-0.971 (all P<0.05). The correlation coefficients of third-level indicators and their corresponding first-level indicators were 0.412-0.904 (all P<0.05). Conclusions:Under the guidance of "one practice and three learning", the teaching ability evaluation indicators for diversified general medicine course teachers have high specificity, rationale structure, high feasibility, high reliability, and high practicability. This evaluation system can provide theoretical reference for the training of undergraduate students in general medicine.

With the core of "molecules and cells", the integrated curriculum group of School of Basic Medical Sciences, Lanzhou University, focuses on the transfer of life molecules, reorganizes teaching content, and integrates Medical Cell Biology, Biochemistry and Molecular Biology, and Medical Genetics to construct a new integrated course of Molecular Medicine. The curriculum group actively explores and practices the mode of medical integration through reconstruction of the curriculum system and optimization of the course content. On the basis of establishing the online course system, the group explores the diversified teaching methods and evaluation systems suitable for Molecular Medicine and discusses the problems in curriculum construction.

Background Nonylphenol (NP) is a typical phenolic endocrine disruptor, and there are significant differences in NP concentration in different regions and water types. Objective To investigate the concentration of NP in three types (river, lake, and reservoir) of water sources in Hubei Province, and assess its ecological risk and population health risk. Methods Fifteen sampling points were set up at four river water sources (Liangtingshan Waterworks, Baishazhou Waterworks, Dijiao Waterworks, and Zongguan Waterworks), one lake water source (Liangzi Lake), and one reservoir water source (Fushui Reservoir). Water samples were collected from the 15 sampling points in June 2019 (wet season), October 2019 (level season), and December 2019 (dry season), respectively. The NP concentration in water samples was detected using ultra-high-performance liquid chromatography-tandem mass spectrometry, and the differences in NP concentration among groups were compared using variance analysis. The ecological risk and the health risk of NP were evaluated using risk quotient (RQ) and non-carcinogenic risk index (NCRI), respectively. Results The detection rate of NP was 100%, with an average concentration of (18.10±15.00) ng·L⁻¹ (5.45-92.71 ng·L⁻¹). The average concentrations of NP during the level, wet, and dry seasons were (11.52±5.31) ng·L⁻¹, (23.86±22.08) ng·L⁻¹, and (18.93±9.51) ng·L⁻¹, respectively, and the maximum concentrations were 24.62 ng·L⁻¹, 92.71 ng·L⁻¹, and 42.38 ng·L⁻¹, respectively. The variance analysis showed no statistical difference in the NP concentration in the samples from rivers, lakes, and reservoirs in different periods (P>0.05). Only the water samples from the water source serving the Zongguan Waterworks showed an RQ (0.19) greater than 0.1 during the wet season, indicating a moderate risk. The RQ values of other water samples were all less than 0.1, indicating an overall relatively low ecological risk. The highest NCRI values during the level, wet, and dry seasons were 0.1459, 0.5492, and 0.2511, respectively, all less than 1, indicating an acceptable health risk level. Conclusion The NP concentrations in all water sources in this study are at a relatively low level, which poses an acceptable risk level to human health.

There are various etiologies for extrahepatic bile duct stenosis， and pharmacotherapy and endoscopic intervention can achieve a good clinical effect in benign stenosis. Early diagnosis and timely surgical treatment of malignant stenosis may prolong the survival time of patients. However， there are still difficulties in the differential diagnosis of malignant bile duct stenosis. This article reviews the application of serology， radiology， endoscopic techniques， and artificial intelligence in the differential diagnosis of malignant bile duct stenosis， so as to provide strategies and references for formulating clinical diagnosis and treatment regimens.