Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

The Third Plenary Session of the 20th Central Committee of the Communist Party of China puts forward the"health priority development strategy",marking that giving priority to health development has become an overall task of further deepening reform in the New Era.The health oriented development strategy is determined by the nature and purpose of the Communist Party of China,and has its historical inevitability and practical necessity."Giving priority to health development"is a collection of series concepts and development models that place the maintenance and promotion of health as the priority in the economic and social development goals,fields and matters of development,based on the basic status and leading role of health.The"health priority development strategy"is the institutionalization,systematization and integration of the concepts and models of giving priority to health development.It is a comprehensive strategy to realize the coordinated and mutually promoting development of health with economy and society.Prioritizing health development is a relative priority to the whole system,it is a development concept and value-oriented approach with free and comprehensive human development at core,it is a health-oriented model and path to achieve high-quality development,and it is a systematic project involving changes in values,lifestyles and modes of production,consumption,governance and institutional systems.The system of prioritizing health development is an organically linked institutional complex formed around the maintenance and promotion of people's health and various norms of conduct,and its practical requirements include the"priority"of concept,planning,policy,investment,team,organization and assessment.

Objective From the perspective of China's health service system,to evaluate the economy of the first-line treatment of advanced squamous non-small cell lung cancer with serplulimab combined with chemotherapy.Methods A three-state partitioned survival model was constructed,and the cost-effectiveness method was used to evaluate the economy of serplulimab combined chemotherapy in the first-line treatment of advanced squamous non-small cell lung cancer.The clinical data were collected from the ASTRUM-004 trial.The quality adjusted life years(QALYs)were used as the output index and the incremental cost-effectiveness ratio(ICER)was calculated.The stability of the model was verified by sensitivity analysis,and the situation analysis was carried out for the decrease of the price of serplulimab.Results The results of basic analysis showed that the cost of the combination group increased by 1 951 442 yuan compared with the placebo combination chemotherapy group,and the ICER was 2 498 816.54 yuan/QALY.Single factor sensitivity analysis showed that PFS state utility value,body weight,and serplulimab price had a greater impact on ICER.Probabilistic sensitivity analysis showed that the basic analysis results are robust.The results of the scenario analysis showed that when the price of serplulimab was reduced by 20％and 80％,it was not economical.Conclusions From the perspective of the China's health service system,currently,the combination therapy of serplulimab with chemotherapy is not cost-effective in the first-line treatment of advanced squamous cell lung cancer compared to placebo combination therapy.

Objective Examine and analyze the current situation of the construction of national regional medical centers for children in China,in order to provide reference for promoting the high-quality development of national regional medical centers for children and other categories.Methods Refer to literature and official websites of relevant national departments and hospitals to obtain the required data and establish an analysis database for children's national regional medical centers.Using PEST analysis method,conduct research from four perspectives:politics,economy,society,and technology.Results The development trend of national regional medical centers for children is good,with a favorable policy environment,increasing demand for children's medical and health services,and high social expectations.However,there are issues such as targeted support policies that need to be improved,varying levels of economic security,regional cultural conflicts,and differences in technological resource levels.Conclusion It is suggested to improve the targeted policy support system,establish a sound compensation mechanism,actively integrate into the overall development of regional society,and integrate the advantages of various technological resources.

Objective:To investigate the application value of self-pulling latter transection(SPLT)in esophagojeju-nal anastomosis during total laparoscopic total gastrectomy.Methods:From January 2021 to December 2023,80 pa-tients who underwent total laparoscopic total gastrectomy at the Department of General Surgery,Yancheng Third People's Hospital,were selected.Patients were grouped based on the intraoperative esophagojejunal anastomosis method:the SPLT group(35 cases,using SPLT esophagojejunostomy)and the Overlap group(45 cases,using esoph-agojejunal overlapping side-to-side anastomosis).Surgical related indicators,complication incidence,nutritional status,and quality of life assessment were compared between the two groups.Results:The time to first postoperative anal exhaust,the number of lymph nodes dissected,and the postoperative hospital stay were compared between the two groups(P＞0.05).The SPLT group had shorter operation time and esophagojejunal anastomosis time,and less intraopera-tive blood loss compared to the control group(P＜0.05).The incidence of postoperative complications in the SPLT group was 8.57%,and in the Overlap group was 11.11%,with no significant difference between the two groups(P＞0.05).The nutritional status at 6 months postoperatively in the SPLT group[Hb(116.97±10.94)g/L、ALB(39.74±1.29)g/L、PA(0.30±0.45)g/L]and Overlap group[Hb(119.78±12.84)g/L、ALB(39.64±1.42)g/L、PA(0.30±0.36)g/L]were compared(P＞0.05).The quality of life assessment(overall health status,functional domains,symptom domains)at 6 months postoperatively between the SPLT group and the Overlap group was compared(P＞0.05).Conclusion:The use of SPLT esophagojeju-nal anastomosis in total laparoscopic total gastrectomy can improve the surgical efficiency,achieve high anastomosis,and its medium and short-term safety is comparable to that of esophagojejunal overlap side-to-side anastomosis.

Objective To assess the therapeutic effect of acupuncture in depressive disorders based on current randomized controlled trials(RCTs).Method RCTs on acupuncture interventions for primary depression by searching databases including CNKI,Wanfang,VIP,Sinomed,PubMed,and Embase.Two researchers independently assessed the quality of the literature,extracted data according to the latest Cochrane Handbook for Systematic Reviews of Interventions,and cross-checked the data.Meta-analysis was performed using RevMan 5.4 software.Result A total of 52 studies were included,comprising 5277 patients.The meta-analysis results showed that acupuncture significantly improved depression symptoms as measured by the Hamilton Depression Rating Scale(HAMD)and reduced clinical inefficacy rates{HAMD-17:WMD=-2.35,95%CI[-3.04,-1.67],P<0.000 01;HAMD-24:WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;HAMD(unspecified scale):WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;Clinical inefficacy:RR=0.39,95%CI[0.33,0.47],P<0.000 01}.Additionally,acupuncture increased 5-HT levels(SMD=1.11,95%CI[0.67,1.55],P<0.000 01).In terms of safety,acupuncture did not increase the incidence of adverse events and reduced TESS scores{Adverse event incidence:RR=0.65,95%CI[0.47,0.89],P=0.007;TESS scores:WMD=-1.66,95%CI[-3.12,-0.20],P=0.03}.There is potential publication bias regarding clinical inefficacy and adverse events,necessitating cautious interpretation.Conclusion Based on the current evidence,acupuncture is an effective and safe treatment for depressive disorders.However,more high-quality RCTs are needed to further validate or refine these conclusions.

Objective:To screen out the disinfection procedure and disinfectant suitable for the actual production of specific pathogen free(SPF)chicken embryo eggs,so as to ensure the disinfection effect of specific pathogen free(SPF)chicken embryo eggs in vaccine production.Methods:This study compares the microbial counting methods of soaking,swabbing with cotton swabs and pouring after thin-film filtration for SPF chicken embryo eggs in a GMP production workshop,and selects the most suitable method for SPF chicken embryo egg microbial counting.Experi-mental groups A,B,and C use self-prepared concentrations of 1∶50 sporicidal agent dilution solution,1∶128 alka-line phenol salt dilution solution,and ready-to-use compound quaternary ammonium disinfectant(sterile),respec-tively,and follow the actual disinfection procedures in the workshop to disinfect and sample the surfaces of SPF chicken embryo eggs entering different cleanliness grades,while using sterile water instead of disinfectant as the control group.The average bactericidal rate is calculated by recording the number of colonies and monitoring the viability of chicken embryo cells using microbial culture,and the disinfection effect of the three disinfectants on SPF chicken embryo eggs is evaluated.Results:The comparison of the results from the three methods shows that the method of sampling SPF chicken embryo eggs by immersion and then counting the microbial colonies through membrane filtration is superior to the other two methods.The final cleaning rate of the control group,which used sterilized injection water to clean the SPF chicken embryo eggs,was 91.67％to 96.97％,while the final steriliza-tion rate of the experimental group,which used the above three disinfectants to disinfect the SPF chicken embryo eggs,was 100.00％.By comparing the cell counts of the experimental group and the control group,it was found that the live cell density of the control group was(6.03-6.25)× 105 cells·mL-1,and that of the experimental groups A-C was(6.08-6.17)× 105 cells·mL-1,(5.99-6.25)× 105 cells·mL-1,and(5.87-6.21)× 105 cells·mL-1 respectively;the cell viability of the control group was 90.33％to 91.35％,and that of the experi-mental groups A-C was 88.25％to 92.12％,89.45％to 93.59％,and 88.02％to 92.89％respectively.Through statistical analysis,it was found that the P values of all experimental groups compared with the control group were greater than 0.05,indicating no statistically significant difference.Conclusion:By comparing the dis-infection effects,cell density and cell viability of the three disinfectants and comprehensively considering factors such as cost and risk of the three disinfectants,1∶50 sporicide dilution,1∶128 alkaline phenolate dilution and ready-to-use compound quaternary ammonium salt disinfectant(sterile)can all be used for the daily surface disin-fection of SPF chicken embryo eggs in the production workshop.The selection of an appropriate disinfectant should be based on specific application scenarios and requirements.

Objective:the subclavian approach without insufflation, the ability of assistants to master the technique of holding the endoscope plays a crucial role in the thoroughness and smoothness of the surgery. The author has summarized the "six-marker method", which adjusts the mirror holding technique based on surgical steps and surgical operation goals, so that assistants can quickly grasp the essentials of mirror holding and assist the chief surgeon in completing the surgery smoothly. This method has wide applicability and feasibility, which can achieve good coordination between the surgeon and the mirror holder, shorten the surgical time and break in period. It is worth promoting and applying in clinical practice.

Objective:To evaluate the training efficacy of the autonomic nervous system stability assessing and enhancing capsule (hereinafter referred to as the EC), and to study the difference in physiological indicators for autonomic nervous system stability training between the EC and a non-capsule environment.Methods:A total of 1 478 male military pilots under autonomic nervous system stability training between February 2022 and February 2024 were selected before they completed training sessions in both the EC and a non-capsule environment. The pre-training time-domain and frequency-domain indices of heart rate variability (HRV) and the 0.1 Hz index were compared with the post-training ones, and across difficulty levels (low, moderate, and high). The difference that the EC made in relaxation training was analyzed.Results:①Time-domain indices of HRV were of statistical significance in the main effects of training difficulty, those of training environments, and their interactions ( F=4.40-160.80, all P<0.05 or 0.01). Simple effect analysis revealed that in the same phase of training the standard deviation of all NN intervals (SDNN) at the low level of difficulty in the EC was lower than in the non-capsule environment. However, all time-domain indices after training were higher in the EC than in the non-capsule environment. The differences were statistically significant (all P<0.05 or 0.01).②For frequency-domain HRV indices, significant differences were observed in both the main effect of training difficulty and the interactions ( F=4.40-1 524.33, all P<0.01). Very low frequency power (VLF), high frequency (HF), the ratio of low frequency to high frequency (LF/HF), normalized low frequency (LFnorm), and normalized high frequency (HFnorm) were significantly different in the main effect of training environments ( F=4.24, 12.00, 6.91, 23.39, 23.39, P=0.040, <0.001, =0.009, <0.001, <0.001). Simple effect analysis revealed that at the same level of training difficulty, the EC delivered significantly lower values of LF and LFnorm but higher values of HF and HFnorm than the non-capsule environment before training (all P<0.05). VLF across levels of training difficulty and LF/HF at the high level of difficulty level were significantly lower in the EC than in the non-capsule environment. After training, total power, VLF, LF, HF, and HFnorm were significantly higher in the EC than in the non-capsule environment, but LF/HF and LFnorm were significantly lower (all P<0.05). ③For the 0.1 Hz index, significant differences were observed in both the main effect of training difficulty and the interactions ( F=2 147.75, 6.63, both P<0.001). Subsequent simple effect analysis revealed that at the same level of training difficulty, 0.1 Hz indices of pilots in the EC were lower than in the non-capsule environment before and after training (all P<0.01). Conclusions:During the autonomic nervous system stability training, the EC can effectively and quickly regulate and alleviate pilots′ fatigue and stress. Furthermore, it provides sustained autonomic nervous system training, thereby stabilizing pilots′ autonomic nervous system.

Objective To assess the therapeutic effect of acupuncture in depressive disorders based on current randomized controlled trials(RCTs).Method RCTs on acupuncture interventions for primary depression by searching databases including CNKI,Wanfang,VIP,Sinomed,PubMed,and Embase.Two researchers independently assessed the quality of the literature,extracted data according to the latest Cochrane Handbook for Systematic Reviews of Interventions,and cross-checked the data.Meta-analysis was performed using RevMan 5.4 software.Result A total of 52 studies were included,comprising 5277 patients.The meta-analysis results showed that acupuncture significantly improved depression symptoms as measured by the Hamilton Depression Rating Scale(HAMD)and reduced clinical inefficacy rates{HAMD-17:WMD=-2.35,95%CI[-3.04,-1.67],P<0.000 01;HAMD-24:WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;HAMD(unspecified scale):WMD=-2.77,95%CI[-3.52,-2.03],P<0.000 01;Clinical inefficacy:RR=0.39,95%CI[0.33,0.47],P<0.000 01}.Additionally,acupuncture increased 5-HT levels(SMD=1.11,95%CI[0.67,1.55],P<0.000 01).In terms of safety,acupuncture did not increase the incidence of adverse events and reduced TESS scores{Adverse event incidence:RR=0.65,95%CI[0.47,0.89],P=0.007;TESS scores:WMD=-1.66,95%CI[-3.12,-0.20],P=0.03}.There is potential publication bias regarding clinical inefficacy and adverse events,necessitating cautious interpretation.Conclusion Based on the current evidence,acupuncture is an effective and safe treatment for depressive disorders.However,more high-quality RCTs are needed to further validate or refine these conclusions.