Gastrointestinal (GI) cancers are a leading cause of cancer morbidity and mortality worldwide. Despite advances in treatment, cancer relapse remains a significant challenge, necessitating novel therapeutic strategies. In this study, we engineered nanobody-based chimeric antigen receptor (CAR) natural killer (NK) cells targeting cadherin 17 (CDH17) for the treatment of GI tumors. In addition, to enhance the efficacy of CAR-NK cells, we also incorporated CV1, a CD47-SIRPα axis inhibitor, to evaluate the anti-tumor effect of this combination. We found that CDH17-CAR-NK cells effectively eliminated GI cancers cells in a CDH17-dependent manner. CDH17-CAR-NK cells also exhibit potent in vivo anti-tumor effects in cancer cell-derived xenograft and patient-derived xenograft mouse models. Additionally, the anti-tumor activity of CDH17-CAR-NK cells is synergistically enhanced by CD47-signal regulatory protein α (SIRPα) axis inhibitor CV1, likely through augmented macrophages activation and an increase in M1-phenotype macrophages in the tumor microenvironment. Collectively, our findings suggest that CDH17-targeting CAR-NK cells are a promising strategy for GI cancers. The combination of CDH17-CAR-NK cells with CV1 emerges as a potential combinatorial approach to overcome the limitations of CAR-NK therapy. Further investigations are warranted to speed up the clinical translation of these findings.

Objective:To deconstruct the overall medical expense and analyze systemic characteristics of cost structure dynamics in China from the perspective of optimizing healthcare resource allocation.Methods:Utilizing hospitalization records in a sample city from 2022-2023 as the research literature,the linear regression models for different cost components was established over the two-year period within each DRG-based case group to identify statistically significant temporal trends and directional changes in cost structures.Results:Most DRG groups exhibited significant trends in at least one cost component.Notable concentration patterns emerged in medication,comprehensive care and therapeutic service costs.When evaluating structure improvement,most achieved optimized allocation in at least one major cost component.Conclusion:The sample city demonstrates continuous optimization in healthcare cost structures,yet specific cost categories and DRG groups deviated from resource allocation optimization goals.Policy interventions should prioritize granular,DRG-specific adjustments to address heterogeneous structural dynamics.

Objective:To deconstruct the overall medical expense and analyze systemic characteristics of cost structure dynamics in China from the perspective of optimizing healthcare resource allocation.Methods:Utilizing hospitalization records in a sample city from 2022-2023 as the research literature,the linear regression models for different cost components was established over the two-year period within each DRG-based case group to identify statistically significant temporal trends and directional changes in cost structures.Results:Most DRG groups exhibited significant trends in at least one cost component.Notable concentration patterns emerged in medication,comprehensive care and therapeutic service costs.When evaluating structure improvement,most achieved optimized allocation in at least one major cost component.Conclusion:The sample city demonstrates continuous optimization in healthcare cost structures,yet specific cost categories and DRG groups deviated from resource allocation optimization goals.Policy interventions should prioritize granular,DRG-specific adjustments to address heterogeneous structural dynamics.

In China,the cost weight of Diagnosis Related Group (DRG) payment generally adopts the historical data method. In order to adapt to medical costs at different levels of hospitals,medical insurance departments often set a grade coefficient to adjust the payment standard. However,the grade coefficient could solidify the"siphon effect"of high-level hospitals to some extent. In order to promote hierarchical diagnosis and treatment,some region select certain basic group which is suitable for treatment in primary hospitals,and cancel grade coefficient to achieve"same disease same price". It discusses the background and principle of same-disease-same-price policy,sorts out the current implementation status,analyzes the selection criteria and characteristics of basic DRG group and evaluates whether the selected groups coordinate policy principle,so as to provide references for improving the reform of DRG payment and promoting the hierarchical diagnosis and treatment system in China.

In China,the cost weight of Diagnosis Related Group (DRG) payment generally adopts the historical data method. In order to adapt to medical costs at different levels of hospitals,medical insurance departments often set a grade coefficient to adjust the payment standard. However,the grade coefficient could solidify the"siphon effect"of high-level hospitals to some extent. In order to promote hierarchical diagnosis and treatment,some region select certain basic group which is suitable for treatment in primary hospitals,and cancel grade coefficient to achieve"same disease same price". It discusses the background and principle of same-disease-same-price policy,sorts out the current implementation status,analyzes the selection criteria and characteristics of basic DRG group and evaluates whether the selected groups coordinate policy principle,so as to provide references for improving the reform of DRG payment and promoting the hierarchical diagnosis and treatment system in China.

Objective:To analyze the survival time, prognostic factors and the value of postoperative thoracic radiotherapy in resected small cell lung cancer (SCLC) patients.Methods:Clinic opathological data of SCLC patients who received surgical treatment in Cancer Hospital & General Hospital of Ningxia Medical University from April 2014 to September 2021 were enrolled in this retrospective study. All patients were subject to follow-up. The survival time of SCLC patients was evaluated by Kaplan-Meier method. Univariate and multivariate analyses of prognostic factors were performed by Cox proportional hazard model.Results:A total of 64 patients with SCLC were enrolled in the study. The 5-year overall survival (OS) rate was 43.5%. Univariate analysis showed that TNM staging ( P=0.027), postoperative neutrophil-lymphocyte ratio (NLR) ( P=0.039) and adjuvant thoracic radiotherapy ( P=0.041) were the prognostic factors. Multivariate analysis showed that TNM staging ( P=0.038) and adjuvant thoracic radiotherapy ( P=0.022) were the prognostic factors in patients with SCLC. The 5-year OS rates of patients with and without adjuvant thoracic radiotherapy were 71.6% and 35.4% ( P=0.028), respectively. There was a statistically significant difference in the 5-year OS rates between pathological stage N 2 SCLC patients with or without adjuvant thoracic radiotherapy (75.0% vs. 0%, P=0.030). Conclusions:TNM staging and postoperative adjuvant thoracic radiotherapy are prognostic factors in patients with SCLC undergoing surgical treatment. Pathological stage N 2 SCLC patients can benefit from adjuvant thoracic radiotherapy.

OBJECTIVE To analyze the implementation experience of France’s additional list system for innovative medical products， and to provide reference for China to support medical institutions to use innovative medical products. METHODS Taking France as a case study， using policy analysis method， this paper systematically studied the practice of establishing additional list system to compensate for innovative medical products in France under diagnosis-related group （DRG） payment， including the establishment background， selection procedure and implementation effect. The suggestions were provided on the medical insurance payment methods for innovative medical products in China. RESULTS & CONCLUSIONS The additional list system established a compensation and payment system for innovative medical products with significant clinical efficacy but high treatment cost， covering four stages： application， evaluation， payment and adjustment， which effectively reduced the drug burden on medical institutions， promoted the use of innovative pharmaceutical products by medical institutions， and stimulated the innovation drive of the pharmaceutical industry， but at the same time brought payment pressure to the medical insurance fund. With the rapid spread of our DRG/diagnosis-intervention packet payment reform of China， some regions have also explored the establishment of a compensation and payment mechanism for innovative medical products， but there are still imperfections. We can refer to the implementation experience of the French additional list system and establish an effective compensation and payment system for innovative medical products starting from the establishment of selection criteria， the selection of compensation mode and the implementation of dynamic adjustment.

OBJECTIVE：To learn from the experience of foreign listed chimeric antigen receptor T lymphocyte （CAR-T） products in signing risk sharing agreements in medical insurance access ，so as to provide references for relevant decisions of medical insurance departments in China. METHODS ：Taking 9 risk sharing agreements of CAR-T products marketed in the United Kingdom，France，Italy and Germany as samples ，the international experience of medical insurance payment of CAR-T products were analyzed from six dimensions ，such as agreement types ，monitoring indicators ，data collection metho ds，agreement periods ， payment conditions and payment methods. Some suggestions were put forward for the medical insurance access of these products in China. RESULTS & CONCLUSIONS ：Four sample countries generally signed risk sharing agreements of medical insurance access （financial agreement and performance-based agreement ）with pharmaceutical enterprises ；the indicators such as progressive disease and progression-free survival were collected by using data collection system or clinical research data ，so as to monitor the efficacy and safety of CAR-T products. The agreement periods and payment conditions were determined according to different agreement types；“medical insurance advance payment ”or“pharmaceutical enterprise advance payment ”combined with “staged payments ” were adopted for risk control. Solving the risk of medical insurance funds caused by “efficacy uncertainty ”is the core issue of CAR-T product access. The induction of risk sharing agreements may be the way to solve this problem ，and the scientific design of the various elements of risk sharing agreements is a prerequisite to ensure that the agreement is operational.

The access negotiations of National Reimbursement Drug List (NRDL) in China from 2017 to 2019 effectively improved the availability and affordability of high-value innovative drugs. However,the actual outpatient reimbursement of most negotiated drugs is lower,which affects the patients" health insurance funds. In this paper,97 negotiated drugs in 337 overall planning cities were selected as samples to analyze the outpatient reimbursement for negotiated drugs. The results showed that the reimbursement level of 40 negotiated drugs was less than 50% in over 70% cities,which can be mainly interpreted as absence or imperfection of outpatient reimbursement policies for special diseases. Finally,this paper puts forward suggestions and protocols for improving the outpatient medical insurance through realizing outpatient overall planning,improving outpatient reimbursement policies for special diseases,and exploring innovative payment,ensuring the achievement of the access to NRDL.

In the process of deepening the reform of the medical and health system, purchasing process as an important link to control health care costs, has an important influence on the formation of drugs and medical consumables value chain. Compared with drugs, medical consumables have the characteristics of complex and diverse models, varieties, manufacturers, etc. So the purchasing system of medical consumables is urgently needed to establish and standardize the procurement. This paper, regarding the classification of procurement as the research object, analyzes the necessity of material classification, and referring to the typical medical consumables purchase mode, probes the existing problem and puts forward some suggestions and solutions to improve the classification system of medical consumables.
China ; Commerce ; Equipment and Supplies ; economics