OBJECTIVE To evaluate the cost-effectiveness of anlotinib combined with penpulimab versus sorafenib as first- line treatment for unresectable hepatocellular carcinoma （uHCC） from the perspective of China’s healthcare system. METHODS Based on data from the APOLLO study， a partitioned survival model was established with a 21-day model cycle to simulate patient survival status over 10 years under anlotinib combined with penpulimab regimen or sorafenib monotherapy. Quality-adjusted life year （QALY） was used as the core evaluation parameter to assess the incremental cost-effectiveness ratio （ICER） of different treatment regimens. Using 3 times China’s per capita gross domestic product （GDP） in 2024 （287 247 yuan/QALY） as the willingness-to-pay （WTP） threshold， cost-utility analysis was performed to evaluate the cost-effectiveness of the treatment regimens. Sensitivity analysis was conducted to validate the robustness of the baseline analysis conclusion. Scenario analysis was performed to consider the impact of anlotinib and penpulimab assistance programs on the results； the price reduction of penpulimab to ensure the cost-effectiveness of the combination regimen was examined under varying WTP thresholds （specifically， 1， 2， and 3 times China’s per capita GDP in 2024）. RESULTS The baseline analysis revealed that the ICER of anlotinib combined with penpulimab regimen relative to the sorafenib regimen was 338 611.20 yuan/QALY， which exceeded the WTP threshold set in this study. Univariate sensitivity analysis indicated that the utility value of progression free survival and penpulimab price significantly influenced the baseline analysis results. Probabilistic sensitivity analysis validated the robustness of the baseline results. The results of scenario analysis indicated that when considering the assistance programs for anlotinib and penpulimab， the obtained ICER values were all below the WTP threshold set at 3 times China’s per capita GDP in 2024. When the price of penpulimab was reduced by 58%， 35%， and 13%， the ICER values were below the WTP threshold， which was 1， 2 and 3 times the per capita GDP of China in 2024， respectively. CONCLUSIONS From the perspective of China’s healthcare system， anlotinib combined with penpulimab regimen for first-line treatment of uHCC lacks cost-effectiveness compared to sorafenib regimen. However， this conclusion would be reversed if the anlotinib and penpulimab assistance programs are taken into account or if the price of penpulimab is reduced by more than 13% and above.

ObjectiveTo establish a mouse model of rheumatoid arthritis with interstitial lung disease （RA-ILD） in DBA/1 mice using Porphyromonas gingivalis （Pg） infection combined with collagen-induced arthritis （CIA）， and to comprehensively evaluate pathological characteristics in joints， lungs， and serum. MethodsForty DBA/1 mice were randomly divided into four groups， i.e.， Control， Pg infection （Pg）， CIA， and Pg infection combined with CIA （Pg+CIA）， with 10 mice in each group. Arthritis clinical symptoms were evaluated by recording arthritis incidence and clinical scores. Micro-CT scanning was used to assess knee joint pathology. Histopathological changes and collagen deposition in knee joints and lung tissues were analyzed using hematoxylin-eosin （HE） and Masson staining. Immunohistochemistry was performed to detect protein expression of α-smooth muscle actin （α-SMA）， typeⅠ collagen （ColⅠ）， and fibronectin （FN） in lung tissues. Real-time quantitative polymerase chain reaction（Real-time PCR）was used to measure mRNA expression levels of α-SMA， ColⅠ， FN， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and IL-1β in lung tissues. Enzyme-linked immunosorbent assay （ELISA） was used to detect serum levels of Pg， cyclic citrullinated peptide （CCP）， and immunoglobulin G （IgG）. ResultsJoint lesions： The CIA and Pg+CIA groups showed 100% arthritis incidence， with evident joint redness， swelling， and deformity. The number of affected limbs was 27 and 28， and clinical scores were 68 and 70， respectively. No obvious clinical symptoms were observed in the Pg group. Histopathological and imaging analyses showed severe joint lesions in the CIA and Pg+CIA groups， with significantly increased histopathological scores， bone mineral density， bone volume fraction， trabecular thickness， and trabecular number compared to the Control group （P<0.01）. No obvious joint pathology was observed in the Pg group. Lung lesions： The Pg+CIA group exhibited marked alveolar inflammation， interstitial inflammatory cell infiltration， and alveolar wall thickening， with pronounced blue staining of collagen fibers. Histopathological scores and collagen area ratios were significantly higher than those of the Control， Pg， and CIA groups （P<0.05）. Lung protein and mRNA expression levels of α-SMA， ColⅠ， and FN were markedly increased， and mRNA levels of IL-6， TNF-α， and IL-1β were significantly elevated compared to the Control group （P<0.05）. Serology： The Pg+CIA group showed significantly higher levels of CCP， Pg， and IgG compared with the Control， Pg， and CIA groups （P<0.05）. ConclusionDBA/1 mice subjected to Pg infection combined with CIA exhibited pronounced symptoms and pathological features of RA-ILD， along with elevated serum anti-CCP antibody levels. This model represents a novel RA-ILD mouse model， providing a valuable experimental tool for investigating RA-ILD pathogenesis and developing new therapeutics， and serves as a basis for establishing anti-cyclic citrullinated peptide antibody （ACPA）-positive RA-ILD animal models.

Functional cure is currently the ideal treatment endpoint for chronic hepatitis B （CHB） in China and globally. HBsAg seroclearance and HBV DNA that cannot be detected in peripheral blood for more than 24 weeks marks the regression of hepatitis B virus （HBV） infection. However， there is still a lack of systematic description of the characteristics of intrahepatic HBV markers after HBsAg seroclearance. This article elaborates on the issues including the latest definition of functional cure， the characteristics of intrahepatic virological markers after HBsAg seroclearance， the significance of ultrasensitive serum HBsAg detection， and antiviral therapy for CHB patients with a low level of HBsAg， so as to improve the understanding of functional cure among clinicians.

OBJECTIVE To investigate the anti-inflammatory effect of electroacupuncture in mice with chronic obstructive pul-monary disease(COPD)and its underlying mechanisms.METHODS Forty C57BL/6 mice were randomly divided into normal group,model group,electroacupuncture(EA)group,vagotomy group,and vagotomy+EA group,with 8 mice in each group.Except for the normal group,all groups were exposed to cigarette smoke for 12 weeks to establish a COPD model.After model establishment,the vagotomy group and the vagotomy+EA group underwent left cervical vagotomy before EA.EA treatment was performed at the Feishu(BL13)and Zusanli(ST36)acupoints once daily for 20 minutes for a total of 14 days.After EA,the pulmonary ventilation function of the mice was detected by a pulmonary function analysis system;lung tissue pathology was observed by HE staining;the levels of inter-leukin(IL)-6,tumor necrosis factor-α(TNF-α),IL-10,and transforming growth factor-β(TGF-β)in lung tissue were detected by ELISA;the expression of CD86 and CD206 proteins in lung tissue was detected by Western blot;the distribution of F4/80+CD86+(M1 type)and F4/80+CD206+(M2 type)cells in lung tissue was determined by flow cytometry;the expression of CD86 and CD206 in lung tissue was observed by immunofluorescence.RESULTS Compared with the normal group,the model group showed significantly decreased lung function(P<0.01),obvious lung pathological damage,increased M1 proportion,IL-6,TNF-α,CD86 content and expression(P<0.05,P<0.01),and decreased M2 proportion,IL-10,TGF-β,CD206 content and expression(P<0.01).Compared with the model group,the EA group showed varying degrees of improvement in lung function and pathology;the M1 proportion,IL-6,TNF-α,and CD86 were reduced(P<0.05,P<0.01),while the M2 proportion,IL-10,TGF-β,and CD206 were increased(P<0.05,P<0.01).The vagotomy group showed worsened lung function and pathology,increased IL-6,TNF-α,and CD86 content and expression(P<0.05,P<0.01),and decreased IL-10,TGF-β,and CD206 content and expression(P<0.05,P<0.01).Compared with the EA group,the vagotomy+EA group showed increased M1 proportion,IL-6,TNF-α,and CD86 content and expression(P<0.01),and decreased M2 proportion,IL-10,TGF-β,and CD206 content and expression(P<0.05,P<0.01).CONCLUSION EA at Feishu(BL13)and Zusanli(ST36)acupoints can improve lung function and pulmonary inflammation in COPD mice,promoting the polarization of alveolar macrophages from M1 to M2,which is mediated by the vagus nerve.

Objective To explore the relationship between serum Niemann-pick type C1 like protein1(NPC1L1)and propro-tein convertase subtilisin/kexin type 9(PCSK9)levels and the risk of type 2 diabetes mellitus(T2DM)in Mongolian residents.Methods A total of 72 Mongolian patients with T2DM treated in Peking University Cancer Hospital,Inner Mongolia Hospital and the Affiliated Hospital of Inner Mongolia Medical University from June 2022 to June 2024 were selected as the T2DM group,and 81 healthy people in the same period were selected as the control group.LASSO model and multivariate Logistic regression model were used to screen the risk factors of disease onset.Multiple linear regression was used to analyze the correlation between NPC1L1 and PCSK9 levels and insulin function.Restricted cubic spline(RCS)model was used to analyze the dose-response relationship between NPC1L1 and PCSK9 levels and the incidence of T2DM,and explored the interaction between NPC1L1 and PCSK9 levels on the incidence of T2DM.Results NPC1L1(3.11±0.80 ng/L)and PCSK9(10.63±0.79 ng/L)in T2DM group were significantly higher than those in the control group(0.52±0.22 ng/L,3.21±0.17 ng/L),and the differences were statisti-cally significant(t=27.982,82.443,all P<0.05).NPC1L1(OR=2.458,95%CI=2.364～2.594,P<0.05)and PCSK9(OR=2.905,95%CI=2.541～3.528)were risk factors for T2DM(all P<0.001).The results of multiple linear regression analysis showed that as NPC1L1 and PCSK9 levels increased,FINS,HbA1c,C-P and OGTT levels also increased accordingly.With the increase of NPC1L1 and PCSK9 levels,insulin function also decreased(all P<0.05).The results of RCS model showed that with the increase of NPC1L1 and PCSK9 levels,the probability of T2DM incidence also increased(χ2=22.334,25.537,all P<0.001).No significant interaction was found between NPC1L1,PCSK9 levels and islet function indexes(P>0.05).Conclusion The levels of NPC1L1 and PCSK9 are closely related to the risk of T2DM in Mongolian residents.With the increase of NPC1L1 and PCSK9 levels,the incidence probability of T2DM increases.

Inflammatory bowel disease(IBD)is a common di-gestive system disease with an increasing morbidity year by year.Its pathological mechanisms have not been fully clarified,and there are currently no ideal or effective curative methods.Phos-phodiesterase(PDE)can regulate intracellular cAMP/cGMP levels to mediate downstream signaling pathways,participating in various pathophysiological processes.In recent years,the po-tential efficacy of PDE inhibitors in the treatment of IBD has gradually attracted attention.This article reviews the pharmaco-logical effects and mechanisms of selective PDE subtype inhibi-tors in the prevention and treatment of IBD,providing references for further research of IBD therapeutic drugs.

To effectively carry out community health education and prevention and control of chronic obstructive pulmonary disease(COPD),we conducted a questionnaire survey on the awareness of COPD knowledge among residents aged 40 and above in Jiading District of Shanghai by using two-stage sampling method.We included 1 783 permanent residents in 4 districts and collected 1 666 valid questionnaires.The awareness rates of COPD name,pulmonary function test and related knowledge were 15.9%,11.9%and 17.2%,respectively.For the main symptoms of COPD,the awareness rate of sputum was the lowest(65.2%),of shortness of breath and dyspnea was the highest(78.4%).For the risk factors,the awareness rate of severe respiratory tract infection in childhood was the lowest(67.3%),of smoking was the highest(86.8%).Multiple response analysis showed that mobile phones and computers accounted for the highest proportion of acquiring knowledge of COPD(66.7%).Multivariate logistic regression analysis showed that low educational level,low monthly income,engaged in production and manufacturing,never or less exercise,no use of indoor air improvement measures,no wearing of masks in public places and no vaccination of influenza vaccine per year were associated with lower awareness rate of COPD.The community should improve the way and ability of health science popularization,and carry out health education for key groups.

Objective:To investigate the application effects of ultrasound-guided transversus abdominis plane block with ropivacaine as an adjunct to intrathecal anesthesia in obese parturients undergoing cesarean section.Methods:A total of 120 parturients undergoing cesarean section at Yulin Hospital, The First Affiliated Hospital of Xi'an Jiaotong University, from March 2023 to March 2024, were prospectively included in this study. The patients were randomly divided into two groups: the experimental group and the control group, with 60 patients in each. The control group received intraspinal anesthesia as the primary anesthesia method, while the experimental group additionally received ultrasound-guided transversus abdominis plane block with ropivacaine. Postoperative activity levels, pain scores at 2, 12, and 24 hours, and scores on the 40-Item Quality of Recovery Scale were compared between the two groups.Results:The pain scores at 2, 12, and 24 hours postoperatively in the experimental group were (4.01 ± 0.50), (2.54 ± 0.37), and (1.17 ± 0.11), respectively. These scores were significantly lower than those in the control group [(4.55 ± 0.55), (3.32 ± 0.44), (2.45 ± 0.24), t = 5.33, 10.51, 37.56, all P < 0.05]. The times to first sit up, first eat, and first walk in the experimental group were (4.14 ± 0.77) hours, (7.85 ± 2.01) hours, and (7.54 ± 1.55) hours, respectively. These times were significantly shorter than those in the control group [(4.66 ± 0.71) hours, (8.66 ± 2.16) hours, (9.04 ± 1.22) hours, t = 3.85, 2.13, 5.89, all P < 0.05]. The scores on the 40-Item Quality of Recovery Scale at 2, 12, and 24 hours postoperatively in the experimental group were (124.74 ± 8.94), (166.57 ± 9.51), and (187.68 ± 10.17), respectively. These scores were significantly higher than those in the control group [(120.73 ± 7.55), (153.67 ± 9.81), (172.37 ± 10.22), t = 2.65, 7.29, 8.23, all P < 0.05]. The incidence of complications in the experimental group was significantly lower than that in the control group ( χ2 = 5.89, P < 0.05). Conclusions:Ultrasound-guided transversus abdominis plane block with ropivacaine, when used as an adjunct to intrathecal anesthesia, shows promising results in obese parturients undergoing cesarean section. It can effectively reduce pain and facilitate postpartum recovery.

In order to adapt to teaching reform of Medical Immunology and create a"golden course",through teaching prac-tice,our research group proposes a"three-dimensional curriculum teaching system",which organically combines teaching concepts with teaching design and process,with construction of various resources(material libraries),and finally,multi-level teaching evalua-tion is completed to achieve overall unity of teaching.

During decidualization, lactic acid is produced and accumulated in large amounts, becoming a prominent feature of the decidual microenvironment. Lactic acid not only serves as a key product in metabolic pathways, participating in rapid energy generation and conversion, but also influences cellular functional states by regulating the acid-base balance of the microenvironment. Furthermore, as a signaling molecule, lactic acid plays a central role in regulating decidual immune metabolism, promoting decidual angiogenesis, and facilitating trophoblast invasion, all of which are crucial for embryo implantation. In recent years, the role of lactic acid in epigenetics has also gradually emerged, with lactylation modifications involved in regulating gene expression and maintaining the homeostasis of the decidual microenvironment. This article will delve into the specific roles of lactic acid in the decidual microenvironment, aiming to provide new perspectives and theoretical foundations for the study of pregnancy-related diseases.