Objective:To investigate whether there is an association between the total dose of breast cancer radiotherapy, the mean dose of radiation field involving the heart and its substructures, and the long-term incidence of coronary heart disease (CHD) in patients.Methods:A retrospective analysis was conducted on 1125 patients with breast cancer who received radiotherapy with radiation fields involving the hear at Beijing Hospital from January 2009 to June 2022. The heart and its substructures of 54 patients were manually delineated, trained an automatic delineation model, and applied this model to the original radiotherapy planning images to automatically extract dosimetric parameters for the heart and substructures in the original plan. Based on the follow-up results, 1125 breast cancer patients were categorized into the CHD event group ( n=19) and non-event group ( n=1106). Wilcoxon rank-sum test, Chi-square test and adjustment for confounding factors using inverse probability weighting were used to compare the mean radiation dose received by the heart and its substructures, age at presentation, history of smoking, history of alcohol consumption, history of hypertension, and history of diabetes between two groups. The influencing factors of CHD were analyzed by univariate and multivariate logistic regression models. Results:The mean heart dose ( P=0.035), mean dose of right atrium ( P=0.049), right coronary artery ( P=0.013), septum ( P=0.045), and right ventricle ( P=0.039) of the event group were higher than that of the non-event group, and the differences were statistically significant. History of alcohol consumption was an independent risk factor for long-term CHD events in the breast cancer patients ( OR=7.35,95% CI: 1.56-25.58, P=0.004). After adjusting for confounding factors using inverse probability weighting, age at presentation was an independent risk factor for long-term CHD events ( OR=1.03, 95% CI: 1.01-1.05, P=0.004). Conclusions:In the breast cancer population with traditional high-risk factors of CHD receiving radiotherapy, the possibility of CHD probably remains high even if the dose of radiation field involving the heart and its substructures is low. Compared to traditional risk factors of CHD, the mean dose to the heart and its substructures in the radiation field of breast cancer patients exerts less impact on the occurrence of CHD after radiotherapy.

In the context of the new medical reform,the formation mechanism of drug prices is one of the important is-sues of this round of medical reform.Drug prices involve the interests of drug companies,hospitals,patients,and other parties,so it is particularly important to establish a reasonable mechanism for the formation of drug prices to safeguard the interests of all parties.This paper first analyzes the characteristics of drugs and the drug market,and then discusses the actual situation and challenges faced by the formation mechanism of drug prices.On this basis,it proposes basic principles for drug pricing and opti-mization recommendations for the formation mechanism of drug prices in the context of the new medical reform.This can provide a reference for the country to formulate relevant drug price policies and promote the rational development of drug prices.

In the context of the new medical reform,the formation mechanism of drug prices is one of the important is-sues of this round of medical reform.Drug prices involve the interests of drug companies,hospitals,patients,and other parties,so it is particularly important to establish a reasonable mechanism for the formation of drug prices to safeguard the interests of all parties.This paper first analyzes the characteristics of drugs and the drug market,and then discusses the actual situation and challenges faced by the formation mechanism of drug prices.On this basis,it proposes basic principles for drug pricing and opti-mization recommendations for the formation mechanism of drug prices in the context of the new medical reform.This can provide a reference for the country to formulate relevant drug price policies and promote the rational development of drug prices.

Objective:To investigate whether there is an association between the total dose of breast cancer radiotherapy, the mean dose of radiation field involving the heart and its substructures, and the long-term incidence of coronary heart disease (CHD) in patients.Methods:A retrospective analysis was conducted on 1125 patients with breast cancer who received radiotherapy with radiation fields involving the hear at Beijing Hospital from January 2009 to June 2022. The heart and its substructures of 54 patients were manually delineated, trained an automatic delineation model, and applied this model to the original radiotherapy planning images to automatically extract dosimetric parameters for the heart and substructures in the original plan. Based on the follow-up results, 1125 breast cancer patients were categorized into the CHD event group ( n=19) and non-event group ( n=1106). Wilcoxon rank-sum test, Chi-square test and adjustment for confounding factors using inverse probability weighting were used to compare the mean radiation dose received by the heart and its substructures, age at presentation, history of smoking, history of alcohol consumption, history of hypertension, and history of diabetes between two groups. The influencing factors of CHD were analyzed by univariate and multivariate logistic regression models. Results:The mean heart dose ( P=0.035), mean dose of right atrium ( P=0.049), right coronary artery ( P=0.013), septum ( P=0.045), and right ventricle ( P=0.039) of the event group were higher than that of the non-event group, and the differences were statistically significant. History of alcohol consumption was an independent risk factor for long-term CHD events in the breast cancer patients ( OR=7.35,95% CI: 1.56-25.58, P=0.004). After adjusting for confounding factors using inverse probability weighting, age at presentation was an independent risk factor for long-term CHD events ( OR=1.03, 95% CI: 1.01-1.05, P=0.004). Conclusions:In the breast cancer population with traditional high-risk factors of CHD receiving radiotherapy, the possibility of CHD probably remains high even if the dose of radiation field involving the heart and its substructures is low. Compared to traditional risk factors of CHD, the mean dose to the heart and its substructures in the radiation field of breast cancer patients exerts less impact on the occurrence of CHD after radiotherapy.

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Objective:To compare the mid-term clinical effects of AngioJet rheolytic thrombectomy assisted catheter-directed thrombolysis (ART+CDT) with catheter-directed thrombolysis (CDT) in the treatment of acute deep venous thrombosis of lower extremities.Methods:Ninety-one patients admitted to the Department from Jan 2016 to Dec 2017 were placed with inferior vena cava filters and divided into ART+CDT group (30 cases)and CDT group (61 cases). Total urokinase dosge, thrombolytic time, operative cost, length of hospital stay, detumescence rate, thrombus clearance rate, cumulative patency rate of lower limb veins, Villalta score at 2 years and 5 years, thrombosis recurrence rate and chronic venous insufficiency quality of life questionnaire were compared between the two groups.Results:The success rate of surgery was 100% in both groups, there was no mortality. There were significant differences in the short-term postoperative outcomes between the two groups in terms of total dosage of urokinase, thrombolysis time, total cost of surgery, length of hospital stay, detumescence rate, venous patency scores before and after treatment, and venous patency rate (all P<0.05). For the mid- and long-term postoperative outcomes of 2 and 5 years, there were no significant differences in the incidence of PTS, recurrence rate of thrombus, chronic venous function scale, and cumulative patency rate at 2 years (all P>0.05). Conclusions:ART+CDT has a significant advantage over CDT alone in terms of early efficacy and early reopening of blood flow in patients. Both ART+CDT and CDT have a low incidence of PTS and a low recurrence rate of thrombus in the mid-term follow-up, and both have satisfactory performance in the mid- and long-term efficacy of interventional treatment of deep venous thrombosis of lower limbs.

Objective:To investigate the risk factors of the occurrence of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis and the effect of proton pump inhibitor (PPI) on OHE.Methods:This study was led by the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) and Shanghai East Hospital of Tongji University School of Medicine, and a total of 13 hospitals participated. From July 31, 2020 to December 10, 2021, a total of 184 liver cirrhosis patients without prior OHE and with ≥2-year follow-up from the above 2 leading hospitals, and other hospitals such as Guangzhou Eighth People′s Hospital of Guangzhou Medical University and Affiliated Hospital of Zunyi Medical University were enrolled. According to whether OHE occurred during the 2-year follow-up period, the 184 patients were divided into OHE group (22 cases) and non-OHE group (162 cases). The clinical data of all the patients were collected, including the laboratory parameters such as international normalized ratio (INR), the usage of PPI, the occurrence of gastrointestinal bleeding, infection, liver cancer and other complications, and survival status. Multivariate logistic regression model was used to analyze the independent risk factors for OHE in patients with liver cirrhosis. Kaplan-Meier survival curve was performed to analyze the effect of PPI on the survival rate of patients with liver cirrhosis. Chi-square test and Cochran-Mantel-Haenszel test were used for statistical analysis.Results:The result of multivariate logistic regression analysis showed that INR ( OR=11.331, 95% confidence interval (95% CI) 2.415 to 53.156, P =0.002) and PPI ( OR=6.794, 95% CI 2.359 to 19.567, P<0.001) were independent risk factors for OHE in patients with liver cirrhosis. The rate of PPI usage of the OHE group was higher than that of the non-OHE group (72.7%, 16/22 vs. 30.9%, 50/162), and the difference was statistically significant ( χ2=14.76, P<0.001). After the patients with gastrointestinal bleeding, infection and liver diseases-related deaths were excluded respectively, the rates of PPI usage of the OHE group were still higher than that of the non-OHE group (8/12 vs. 21.3%, 27/127; 11/16 vs. 25.0%, 35/140; 12/15 vs. 29.0%, 45/155), and the differences were all statistically significant ( χ2=9.71, 11.20 and 15.94; all P<0.01). Kaplan-Meier survival curve analysis showed that the 2-year cumulative survival rate of liver cirrhosis patients with PPI usage was lower than that of the patients without PPI usage (86.4%, 57/66 vs. 95.8%, 113/118), and the difference was statistically significant ( χ2=5.37, P =0.020). Conclusion:PPI is an independent risk factor for OHE in patients with liver cirrhosis, and may increase the risk of liver disease-related death.

Background and Aims:Graft materials such as covered stents and artificial vascular grafts have been widely used to treat peripheral arterial disease (PAD). However,the increasing prevalence of chronic graft thrombosis and chronic lower limb arterial thrombosis has brought attention to the challenge of removing chronic thrombi. This study evaluated the feasibility of using the Rotarex mechanical thrombectomy system for treating chronic thrombosis formation in PAD patients.Methods:A retrospective analysis was conducted on the clinical data of 10 PAD patients with chronic thrombosis admitted consecutively to the Department of Vascular Surgery,Hainan Provincial People's Hospital,from July 2023 to December 2023. All patients were male,with an average age of (70.4±8.6) years. The cohort included five synthetic graft cases,one with a covered stent and four with autologous arteries. The occlusion sites included the iliac artery (2 cases),superficial femoral artery (7 cases),and popliteal artery (4 cases),with a median occlusion duration of 5.5 (3-38) months. The Rotarex mechanical thrombectomy system was used in combination with balloon angioplasty or stent implantation to restore lower limb blood flow. The debulking success rate,procedural success rate,and changes in hemoglobin (Hb),and ankle-brachial index (ABI) were evaluated. Patients were followed up at 3 and 6 months after operation with ultrasound examination,Rutherford classification,and ABI assessment.Results:The Rotarex mechanical thrombectomy achieved a 100％ success rate in both debulking and procedural outcomes. The median operative time was 150 (120-270) min. All patients underwent percutaneous transluminal angioplasty (PTA) following thrombectomy. Nine stents were deployed in six patients:five in the distal segments of the occluded vessels,three in the proximal segments,and one fully covering the diseased segment. Preoperative Hb was (131.30±24.55) g/L,which decreased to (114.20±25.28) g/L postoperatively,showing a statistically significant difference (t=4.253,P=0.002). The preoperative ABI was 0.46±0.15,which improved to 0.95±0.19 postoperatively,also showing a significant difference (t=17.528,P<0.001). No perioperative complications,such as distal arterial embolism,arterial injury,or acute renal dysfunction,were observed. The follow-up rate was 100％ at 3 months and 80％ at 6 months. At 3 months,ultrasound examinations showed patent target vessels in all patients,with Rutherford classification of grade 0 in 8 cases and grade 1 in 2 cases and an ABI of 0.84±0.17. At 6 months,two patients were lost to follow-up. Among the remaining 8 patients,ultrasound revealed moderate stenosis in 2 cases and patent vessels in 6 cases,with Rutherford classification of grade 0 in 4 cases and grade 1 in 4 cases,and an ABI of 0.76±0.16.Conclusion:The Rotarex mechanical thrombectomy system is a safe and feasible option for treating chronic thrombosis in PAD patients.

Background and Aims:Graft materials such as covered stents and artificial vascular grafts have been widely used to treat peripheral arterial disease (PAD). However,the increasing prevalence of chronic graft thrombosis and chronic lower limb arterial thrombosis has brought attention to the challenge of removing chronic thrombi. This study evaluated the feasibility of using the Rotarex mechanical thrombectomy system for treating chronic thrombosis formation in PAD patients.Methods:A retrospective analysis was conducted on the clinical data of 10 PAD patients with chronic thrombosis admitted consecutively to the Department of Vascular Surgery,Hainan Provincial People's Hospital,from July 2023 to December 2023. All patients were male,with an average age of (70.4±8.6) years. The cohort included five synthetic graft cases,one with a covered stent and four with autologous arteries. The occlusion sites included the iliac artery (2 cases),superficial femoral artery (7 cases),and popliteal artery (4 cases),with a median occlusion duration of 5.5 (3-38) months. The Rotarex mechanical thrombectomy system was used in combination with balloon angioplasty or stent implantation to restore lower limb blood flow. The debulking success rate,procedural success rate,and changes in hemoglobin (Hb),and ankle-brachial index (ABI) were evaluated. Patients were followed up at 3 and 6 months after operation with ultrasound examination,Rutherford classification,and ABI assessment.Results:The Rotarex mechanical thrombectomy achieved a 100％ success rate in both debulking and procedural outcomes. The median operative time was 150 (120-270) min. All patients underwent percutaneous transluminal angioplasty (PTA) following thrombectomy. Nine stents were deployed in six patients:five in the distal segments of the occluded vessels,three in the proximal segments,and one fully covering the diseased segment. Preoperative Hb was (131.30±24.55) g/L,which decreased to (114.20±25.28) g/L postoperatively,showing a statistically significant difference (t=4.253,P=0.002). The preoperative ABI was 0.46±0.15,which improved to 0.95±0.19 postoperatively,also showing a significant difference (t=17.528,P<0.001). No perioperative complications,such as distal arterial embolism,arterial injury,or acute renal dysfunction,were observed. The follow-up rate was 100％ at 3 months and 80％ at 6 months. At 3 months,ultrasound examinations showed patent target vessels in all patients,with Rutherford classification of grade 0 in 8 cases and grade 1 in 2 cases and an ABI of 0.84±0.17. At 6 months,two patients were lost to follow-up. Among the remaining 8 patients,ultrasound revealed moderate stenosis in 2 cases and patent vessels in 6 cases,with Rutherford classification of grade 0 in 4 cases and grade 1 in 4 cases,and an ABI of 0.76±0.16.Conclusion:The Rotarex mechanical thrombectomy system is a safe and feasible option for treating chronic thrombosis in PAD patients.

Objective:To investigate the risk factors of the occurrence of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis and the effect of proton pump inhibitor (PPI) on OHE.Methods:This study was led by the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) and Shanghai East Hospital of Tongji University School of Medicine, and a total of 13 hospitals participated. From July 31, 2020 to December 10, 2021, a total of 184 liver cirrhosis patients without prior OHE and with ≥2-year follow-up from the above 2 leading hospitals, and other hospitals such as Guangzhou Eighth People′s Hospital of Guangzhou Medical University and Affiliated Hospital of Zunyi Medical University were enrolled. According to whether OHE occurred during the 2-year follow-up period, the 184 patients were divided into OHE group (22 cases) and non-OHE group (162 cases). The clinical data of all the patients were collected, including the laboratory parameters such as international normalized ratio (INR), the usage of PPI, the occurrence of gastrointestinal bleeding, infection, liver cancer and other complications, and survival status. Multivariate logistic regression model was used to analyze the independent risk factors for OHE in patients with liver cirrhosis. Kaplan-Meier survival curve was performed to analyze the effect of PPI on the survival rate of patients with liver cirrhosis. Chi-square test and Cochran-Mantel-Haenszel test were used for statistical analysis.Results:The result of multivariate logistic regression analysis showed that INR ( OR=11.331, 95% confidence interval (95% CI) 2.415 to 53.156, P =0.002) and PPI ( OR=6.794, 95% CI 2.359 to 19.567, P<0.001) were independent risk factors for OHE in patients with liver cirrhosis. The rate of PPI usage of the OHE group was higher than that of the non-OHE group (72.7%, 16/22 vs. 30.9%, 50/162), and the difference was statistically significant ( χ2=14.76, P<0.001). After the patients with gastrointestinal bleeding, infection and liver diseases-related deaths were excluded respectively, the rates of PPI usage of the OHE group were still higher than that of the non-OHE group (8/12 vs. 21.3%, 27/127; 11/16 vs. 25.0%, 35/140; 12/15 vs. 29.0%, 45/155), and the differences were all statistically significant ( χ2=9.71, 11.20 and 15.94; all P<0.01). Kaplan-Meier survival curve analysis showed that the 2-year cumulative survival rate of liver cirrhosis patients with PPI usage was lower than that of the patients without PPI usage (86.4%, 57/66 vs. 95.8%, 113/118), and the difference was statistically significant ( χ2=5.37, P =0.020). Conclusion:PPI is an independent risk factor for OHE in patients with liver cirrhosis, and may increase the risk of liver disease-related death.