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 association between the physical fitness index (PFI) and symptoms of depressive, anxiety and stress symptoms among college students, providing a reference for mental health interventions. Methods: From June to September 2025, combined convenience and cluster random sampling approach was used to administer questionnaire surveys and perform physical fitness tests on 2 712 college students from Zhejiang Chinese Medical University. The Depression Anxiety Stress Scales-21 Items (DASS-21) was used to assess mental health status. Chi square test and multivariate Logistic regression analysis were used to determine the associations between the PFI and the PFI component indicators with depressive, anxiety and stress symptoms. Results: The prevalence of depressive, anxiety and stress among college students were 24.26%, 33.22% and 13.68%, respectively. Statistically significant differences in the prevalence of these symptoms were detected across groups differing in sleep quality, physical activity, weekly breakfast frequency, and history of low back or neck pain ( χ 2=9.33-151.83, all P <0.05). After adjusting for confounding factors, Logistic regression revealed that the moderate and high PFI groups had significantly reduced risks of depressive and anxiety compared to the low PFI group ( OR =0.73, 0.63; 0.61, 0.72, all P <0.05). Poor speed (50 m run) and lower body strength (standing long jump) emerged as common risk factors affecting anxiety and depressive symptoms in both male and female college students (all P <0.05). Increased muscle strength (sit up for 1 min) in female students reduced the risk of depressive ( OR =0.81), anxiety ( OR =0.85), and stress symptoms ( OR =0.79) (all P <0.05). Enhanced lung capacity in male students decreased the risk of depressive ( OR =0.84) and anxiety symptoms ( OR =0.85) (both P <0.05). Conclusions The PFI is negatively correlated with depressive and anxiety symptoms among college students with notable gender differences. Insufficient speed and lower body explosive power represent common risk factors for mental health among male and female college students.

Objective To explore the value of artificial intelligence federated learning system based on chest X-ray films for pathogen diagnosis of community-acquired pneumonia(CAP)in children.Methods Totally 900 cases of CAP children from 2 hospitals were retrospectively enrolled,including bacterial,viral and mycoplasma CAP(each n=300),and chest posteroanterior X-ray films were collected.Meanwhile,chest posteroanterior X-ray films of 5856 children from the publicly available dataset GWCMCx were collected,including 4273 CAP images and 1583 healthy chest images.All above 6756 images were divided into training set(n=5359)and validation set(n=1397)at the ratio of 8∶2.Then a pathogen diagnosis model of children CAP was established based on attention mechanism.Binary and ternary diagnostic algorithms were designed,and federated deployment training was performed.The efficacy of this system for pathogen diagnosis of children CAP was analyzed and compared with DenseNet model.Results Based on all data,the accuracy of the obtained artificial intelligence federated learning system model for diagnosing children CAP was 97.00%,with the area under the curve(AUC)of 0.990.Based on hospital data,the AUC of this system using single imaging data and clinical-imaging data for pathogen diagnosis of children CAP was 0.858 and 0.836,respectively,both better than that of DenseNet model(0.740,both P＜0.05).Conclusion The artificial intelligence federated learning system based on chest X-ray films could be used for pathogen diagnosis of children CAP.

Objective To explore the application effect of the Mini-CEX evaluation model based on the OBE concept in the clinical Practice teaching of neurology.Methods We Selected 100 students who will Practice in the Department of Neurology from 2022 to 2023 as the research objects,and divided them into the experimental group(n=50)and the control group(n=50).Under the guidance of the OBE concept,the experimental group was guided by learning outcomes,refined the teaching objectives,and applied the Mini-CEX evaluation mode for evaluation and feedback.In contrast,the control group adopted the traditional teaching mode.Combined with the observation data,we analyzed and compared the data of various indicators of the two groups of students at the beginning and end of the internship.Results At the end of the internship,the scores of clinical consultation,Physical examination,humanistic medicine,clinical diagnosis,health consultation,organizational effect,and overall evaluation of the experimental group were significantly improved and were higher than those of the control group.After the Practice,in terms of skill test scores,the experimental group scored higher than the control group,the difference was statistically significant(P<0.05),and the experimental group also scored higher in satisfaction evaluation than the control group.Conclusion The Mini-CEX evaluation teaching model based on the concept of OBE is applied to the clinical practice teaching of the neurology department,which can enhance the training effect of students'clinical practice skills.

Objective:To compare the antiplatelet effects of vicagrel and clopidogrel in patients with different cytochrome P450 (CYP) 2C19 genotypes.Methods:This is a post-hoc analysis of a phase Ⅱ clinical trial of vicagrel, which included patients with coronary heart disease who underwent percutaneous coronary intervention from August 2018 to June 2019 in 18 centers. Patients were categorized based on the presence of CYP 2C19 *2 or *3 loss-of-function (LOF) alleles into LOF carrier group ( n=111) and non-LOF carrier group ( n=90). Each group included patients received vicagrel 5 mg, 6 mg, 7.5 mg, or clopidogrel 75 mg for 28 days per study protocol. P2Y 12 reaction units (PRU) were measured using VerifyNow at baseline, 6 to 8 hours after loading dose, 7 to 10 days after randomization, and 28 days after randomization and the percentage inhibition of platelet aggregation (%IPA) was calculated. The primary endpoint was %IPA on day 28. Within the patients from the General Hospital of Northern Theater Command, 8 to 12 patients in each study arms were enrolled in a prespecified pharmacokinetic sub-study, measuring the time to reach maximum plasma concentration (T max), peak plasma concentration (C max), and area under the plasma concentration-time curve (AUC). Results:Among 201 patients, the age was (58.8±8.5) years, and 139 (69.2%) were male. In non-LOF carriers, there was no significant differences in PRU values and %IPA between the vicagrel 5 mg, 6 mg, 7 mg, and clopidogrel groups at all time points (all P>0.05). In LOF carriers, %IPA was significantly higher in the vicagrel-treated groups than in the clopidogrel group at 6-8 hours after loading dose (22.9 (14.2, 31.5)% vs. 19.8 (11.0, 28.6)% vs. 29.5 (20.9, 38.0)% vs. 12.9 (3.9, 21.9)%, P=0.038) and 7-10 days after randomization (22.4 (14.2, 30.5)% vs. 34.4 (26.1, 42.6)% vs. 39.8 (31.8, 47.9)% vs. 24.7 (16.3, 33.2)%, P=0.001), with a trend towards higher %IPA in the vicagrel-treated groups at day 28 (30.4 (21.3, 39.6)% vs. 36.5 (27.2, 45.7)% vs. 40.8 (31.8, 49.8)% vs. 30.7(21.2, 40.2)%, P=0.056). Pharmacokinetic results of 35 patients showed that the C max and AUC of the active metabolite M15-2 of vicagrel was similar to that of clopidogrel in non-LOF carriers, but AUC between vicagrel 5 mg, 6 mg, 7 mg and clopidogrel were significantly different in LOF carriers ((5.6±0.6) h·μg -1·L -1 vs. (6.8±2.7) h·μg -1·L -1 vs. (9.2±3.3) h·μg -1·L -1 vs. (4.2±1.9) h·μg -1·ml -1, P=0.020). Conclusion:Vicagrel and clopidogrel have similar antiplatelet effects in non-LOF carriers, but vicagrel exhibits superior antiplatelet effects in LOF carriers.

Objective:To explore the impact of problem-inquiry teaching based on the concept of science-technology-engineering-arts-mathematics (STEAM) on the critical thinking and practical abilities of clinical interns in neurology.Methods:The 194 clinical interns majoring in clinical medicine and enrolled in 2020 were selected as subjects. The 98 interns from classes 1-4 were included in the traditional group with traditional teaching, and the 96 clinical interns from classes 5-8 were included in the teaching reform group with problem-inquiry teaching based on the STEAM concept. After the internship, the assessment scores (basic theoretical knowledge, professional theoretical knowledge, classroom performance), critical thinking, practical ability, and teaching satisfaction were compared between the two groups of interns.Results:The assessment scores of the teaching reform group [(40.97±3.26) for basic theoretical knowledge, (42.12±2.95) for professional theoretical knowledge, and (38.47±2.78) for classroom performance] were significantly higher than those of the traditional group [(38.14±3.07), (40.33±2.83), and (35.89±2.71)] (all P<0.05). After the internship, the California Critical Thinking Disposition Inventory-Chinese Version scores of both groups of clinical interns increased, and the score was higher in the teaching reform group than in the traditional group. The Leicester Assessment Package score (82.49±6.71), case writing score (85.63±5.34), and teaching satisfaction (91.67%) of the teaching reform group were significantly higher than those of the traditional group [(77.35±6.23), (82.57±5.12), and 79.59%] (all P<0.05). Conclusions:Problem-inquiry teaching based on the STEAM concept can improve the theoretical knowledge level of clinical interns in neurology, promote their active speaking, enhance their critical thinking and practical abilities, and increase teaching satisfaction.

Objective:To explore the impact of problem-inquiry teaching based on the concept of science-technology-engineering-arts-mathematics (STEAM) on the critical thinking and practical abilities of clinical interns in neurology.Methods:The 194 clinical interns majoring in clinical medicine and enrolled in 2020 were selected as subjects. The 98 interns from classes 1-4 were included in the traditional group with traditional teaching, and the 96 clinical interns from classes 5-8 were included in the teaching reform group with problem-inquiry teaching based on the STEAM concept. After the internship, the assessment scores (basic theoretical knowledge, professional theoretical knowledge, classroom performance), critical thinking, practical ability, and teaching satisfaction were compared between the two groups of interns.Results:The assessment scores of the teaching reform group [(40.97±3.26) for basic theoretical knowledge, (42.12±2.95) for professional theoretical knowledge, and (38.47±2.78) for classroom performance] were significantly higher than those of the traditional group [(38.14±3.07), (40.33±2.83), and (35.89±2.71)] (all P<0.05). After the internship, the California Critical Thinking Disposition Inventory-Chinese Version scores of both groups of clinical interns increased, and the score was higher in the teaching reform group than in the traditional group. The Leicester Assessment Package score (82.49±6.71), case writing score (85.63±5.34), and teaching satisfaction (91.67%) of the teaching reform group were significantly higher than those of the traditional group [(77.35±6.23), (82.57±5.12), and 79.59%] (all P<0.05). Conclusions:Problem-inquiry teaching based on the STEAM concept can improve the theoretical knowledge level of clinical interns in neurology, promote their active speaking, enhance their critical thinking and practical abilities, and increase teaching satisfaction.

OBJECTIVE To evaluate the efficacy and safety of PD-1/PD-L1 inhibitors for neoadjuvant treatment of bladder cancer， and to provide evidence-based reference for clinical treatment. METHODS Retrieved from PubMed， Cochrane Library， Embase， American Society of Clinical Oncology Meeting Library， CNKI， VIP and Wanfang database， etc.， the randomized controlled trials （RCTs）， non-RCT， case-control studies， cohort studies， etc. about PD-1/PD-L1 inhibitors for neoadjuvant treatment of bladder cancer were collected from the inception to Jan 31st， 2023. After literature screening， data extraction and quality evaluation， RevMan 5.3 software was used to perform meta-analysis of single-group rates； sensitivity analysis and publication bias analysis were conducted using Stata12 software. RESULTS A total of 25 studies were included in this discussion， involving 940 patients. The results of meta-analysis showed that the pathologic complete response （pCR） rate was 32% [OR＝0.32， 95%CI （0.22， 0.45）， P＝0.006]， downstaging rate was 52% [OR＝0.52， 95%CI （0.45， 0.60）， P＝0.55]， and the incidence of ≥grade 3 immune-related adverse events （irAEs） was 16% [OR＝0.16， 95%CI （0.11， 0.22）， P＜0.000 01]. Subgroup analysis showed that the patients receiving PD-1/PD-L1 inhibitors alone had a pCR rate of 25% and a incidence of Grade≥3 irAEs of 9%； the patients receiving combined immunotherapy had a pCR rate of 29% and a incidence of Grade≥3 irAEs of 28%； the patients receiving PD-1/PD-L1 inhibitors combined with chemotherapy had a pCR rate of 43% and a incidence of Grade≥3 irAEs of 12%； PD-L1 positive patients had a pCR rate of 44%， and PD-L1 negative patients had a pCR rate of 25%. The results of the sensitivity analysis showed that the study was robust. The results of the publication bias analysis showed that there was no significant publication bias. CONCLUSIONS PD-1/PD-L1 inhibitors are effective and safe for adjuvant treatment of bladder cancer.

ObjectiveTo explore the mechanism of Chaihu Guizhitang （CHGZT） in alleviating neuropathic abdominal pain induced by 2，4，6-trinitrobenzene sulfonic acid （TNBS） in rats with chronic pancreatitis （CP）. MethodFifty male SD rats were randomly assigned into five groups： sham operation， CP model， and low-， medium-， and high-dose （4， 8， and 16 g·kg^-1， respectively） CHGZT groups. In the sham operation group， the abdomen was closed after the pancreas was gently stirred. The rat model of CP was established by retrograde injection of 2% TNBS-10% ethanol into the pancreatic duct. The oral administration of CHGZT started 4 weeks after modeling and lasted for 2 weeks. Pain threshold was measured by Von Frey fibers 6 weeks after surgery. Hematoxylin-eosin （HE） staining was employed to reveal the chronic inflammation and fibrosis of the pancreatic tissue. Immunohistochemmistry （IHC） was employed to detect the expression of PGP9.5 （a marker of pancreatic nerves） and reveal the inflammatory changes around the nerves. IHC and immunofluorescence （IF） were used to determine the location of ionized calcium-binding adaptor molecule-1 （Iba-1， microglia marker） and purinergic receptor P2X7 （P2RX7） and the co-expression of P2RX7 and Iba-1 in the thoracic spinal dorsal horn. ResultCompared with the sham operation group， the modeling increased the scores of pancreatic gland atrophy， inflammatory infiltration， and fibrosis （P<0.01）， the abdominal pain response under different force values （P<0.05， P<0.01）， and the score of peripancreatic inflammation. Moreover， the modeling up-regulated the expression of Iba-1 and P2RX7 in the thoracic spinal dorsal horn （P<0.01）. Compared with the model group， the high- and medium-dose CHGZT lowered the scores of pancreatic gland atrophy， inflammatory infiltration， and fibrosis， the abdominal pain response， and the score of peripancreatic inflammation （P<0.05， P<0.01）. The high-， medium-， and low-dose CHGZT all down-regulated the expression of Iba-1 and P2RX7 （P<0.01）. ConclusionCHGZT can significantly relieve abdominal pain in CP rat by suppressing the inflammation around nerves in the pancreas and the P2RX7 activation of microglia in the spinal dorsal horn.

OBJECTIVE To explore the impact of the adjustment of the national reimbursement drug list on rare disease drugs in hospitals， and to provide reference for improving the drug security of patients with rare diseases in China.METHODS The monthly procurement data of rare disease drugs from 789 medical institutions that continuously reported data from January 2016 to December 2018 were extracted from the Chinese Medicine Economic Information. The single-group interrupted time series model was used to compare drug varieties， procurement amount， average defined daily cost （DDDc） and defined daily doses （DDDs） of rare disease drugs before and after the adjustment of national reimbursement drug list. RESULTS In 2017， a total of 9 rare disease drugs were newly included in the national reimbursement drug list， including pirfenidone， carbidopa/levodopa， riluzole， ropinirole， droxidopa， ezetimibe， everolimus， coagulation factor Ⅸ human recombinant and coagulation factor Ⅶa human recombinant. After the adjustment of the national reimbursement drug list， the average DDDc of 9 rare disease drugs was significantly decreased， the upward trend of DDDs and the procurement amount was significantly increased （P＜0.001）. CONCLUSIONS The number of newly included rare disease drugs in national reimbursement drug list keeps increasing， the coverage of medical security keeps expanding， the price of rare disease drugs is significantly decreased， the economic burden of patients is further decreased， and the consumption of rare disease drugs is significantly increased， benefiting more patients with rare diseases； but at the same time， it also increases the procurement amount of rare disease drugs in hospitals. National medical security departments need to fully consider how to balance the affordability of medical insurance funds with the demand for rare disease drug coverage.