OBJECTIVE To evaluate the cost-effectiveness of different sequential treatment regimens for human epidermal growth factor receptor 2 （HER-2）-positive advanced gastric cancer from the perspective of the Chinese health system. METHODS Survival data were obtained from the ToGA， WJOG 4007 and RAINBOW-Asia trials， and adjusted using network meta-analysis. A four-state Markov model was constructed to evaluate the cost-effectiveness of six treatment sequences， with a lifetime simulation horizon and a cycle period of 4 weeks （28 d）， and the main output parameters of the model included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analysis was conducted to test the robustness of the basic analysis results， and a price reduction scenario analysis for trastuzumab was performed. RESULTS Compared with chemotherapy sequentially treated with paclitaxel， the ICER of trastuzumab combined with chemotherapy sequentially treated with paclitaxel， or irinotecan， or ramucirumab plus paclitaxel were 349 845.25， 772 410.64， and 2 510 470.39 yuan/QALY， respectively， all exceeding three times China’s 2023 per capita gross domestic product （GDP） （268 074 yuan/QALY） as the willingness-to-pay （WTP） threshold. This indicated that chemotherapy sequential paclitaxel was the optimal treatment regimen. The sensitivity analysis confirmed the robustness of the basic analysis. The scenario analysis showed that when trastuzumab was reduced by more than 20%， trastuzumab combined with chemotherapy sequentially treated with paclitaxel became cost-effective under this study’s WTP threshold. CONCLUSIONS When using three times China’s 2023 per capita GDP as the WTP threshold， chemotherapy sequentially treated with paclitaxel is the optimal regimen for HER-2 positive advanced gastric cancer， with trastuzumab combined with chemotherapy sequentially treated with paclitaxel as the second best option. With enhanced medical insurance optimization， trastuzumab combined with chemotherapy sequentially treated with paclitaxel is expected to become the most cost-effective treatment regimen.

Objective To investigate the value of ¹⁸F-FDG PET/CT metabolic parameters in the prognostic assessment of nasopharyngeal cancer patients. Methods The clinical data and PET/CT metabolic parameters of 185 nasopharyngeal cancer patients were retrospectively analyzed. The collected parameters were SUV_max, MTV, TLG, total metabolic tumor volume (TMTV) and whole-body total lesion glycolysis (WTLG). The ROC curve was used to determine the optimal cut-off values of PET/CT metabolic parameters. Univariate and multivariate Cox regression models were used to screen the independent prognostic factors. Kaplan–Meier curves were used to analyze the survival differences. Results The results of univariate Cox regression analysis showed that age, pathologic type, WTLG, TMTV, MTV, and TLG were closely associated with OS and PFS; and SUV_max was associated with PFS (P<0.05). Multivariate Cox regression analysis results showed that age, TMTV, and WTLG were the independent prognostic factors for OS and PFS (P<0.05). The combination of WTLG with T/N staging (AUC=0.781 and 0.781) and TMTV with T/N staging (AUC=0.800 and 0.790) yielded greater predictive accuracy than that of WTLG and TMTV alone (AUC=0.724 and 0.719) or T/N staging (AUC=0.593 and 0.575). Conclusion TMTV and WTLG are important prognostic predictors of nasopharyngeal carcinoma. TLG and MTV of primary lesions are prognostic factors for patients’ PFS and OS. SUV_max has limited prognostic value. Systemic metabolic indexes (TMTV and WTLG), when combined with T/N staging, can optimize prognostic stratification.

In recent years, the prevalence of obstructive coronary artery disease has continued to rise. Despite the widespread application of strategies such as intensive pharmacotherapy, coronary artery bypass grafting, or percutaneous coronary intervention, a subset of patients still experience recurrent angina symptoms, which severely impacts their quality of life. For such cases of refractory angina (RA), researchers domestically and internationally have explored therapeutic approaches such as spinal cord stimulation, transmyocardial laser revascularization, and sympathectomy. However, existing studies are largely limited to small-scale clinical trials, and their clinical translation still faces challenges due to insufficient validation of safety and efficacy. Injectable hydrogels, as functional materials with hydrophilic three-dimensional network structures, demonstrate unique advantages in the treatment of RA. They can not only provide mechanical support but also serve as controlled-release carriers for drugs and proteins, and synergize with gene therapy and stem cell therapy to promotemyocardial tissue repair. This article systematically reviews the application prospects of injectable hydrogels in the treatment of RA, aiming to provide insights for future therapeutic strategies.

Purpose To investigate the clinicopathological features,immunophenotype,diagnosis and differential diagnosis of superficial CD34-positive fibroblast tumor.Methods Retro-spective analysis was performed in 6 cases of superficial CD34 positive fibroblastic tumors.Routine HE staining was performed under light microscopy,immunohistochemical Eli Vision staining was performed,and FISH was used to detect the PRDM10 gene.Literature review was also conducted.Results Among the 6 SCPFT patients,there were 2 males and 4 females.Four masses were located subcutaneous in the lower limbs,one in the lower abdomen,and one in the vulva.Microscopically,the tumor cells were arranged in bundles or solid patches,with obvious pleomor-phism or deformity of the nucleus and nucleoli.Pseudoinclusion bodies were visible in the nucleus,and the cytoplasm was eosin-ophilic.Some areas of the cells were epithelioid,with no mitotic figures observed.A small amount of inflammatory cells were scattered in the stroma.Immunophenotypically,diffuse and strong expression of CD34 and INI1 was observed in the tumor cells,some cells expressed CK(AE1/AE3),but did not ex-press SMA,CD68,desmin,S-100,CD31,ERG.Ki67 had a value-added index below 3％.FISH detection of PRDM10 gene was performed on 4 cases of SCPFT,and 3 cases were positive.Conclusion Superficial CD34-positive fibroblast tumor is a newly reported soft tissue tumor with borderline or low-grade ma-lignant biological behavior.Diagnosis needs to be differentiated from multiple CD34 positive soft tissue tumors to avoid over diag-nosis and over treatment.

Objective To understand and assess the quality status of national drug sampling inspection in 2022 and the possible risks of drug quality.Methods With the aim of identifying issues and preventing risks,a sampling model of"dispersed sampling,centralized inspection,exploratory research,and comprehensive evaluation"was used to review the historical inspection data of national drug sampling.The overall quality and potential risks of national drug sampling in 2022 were analyzed,with a focus on identifying and examining the main quality problems and risks.Results The average pass rate of the sampling inspection in 2022 was 99.4% .The overall safety situation of China's post-marketing drug quality is stable and manageable,indicating that the drug quality is at a high level.Conclusions By carrying out exploratory studies related to drug safety,authenticity,and efficacy,national sampling plays an important role in comprehensively evaluating the quality status of drugs.It aids in improving the quality control level of drug varieties and industry standards,strengthening quality and safety supervision,combating illegal practices such as adulteration and falsification,and providing public warnings about drug safety.

Objective To investigate the regulatory mechanism of apurnic/apyrimidinic endonuclease 1(APE1)in the transformation of chronic intestinal inflammation to colitis-associated colorectal cancer(CAC).Methods C64S mutant(APE1C64S)mice and APE1 wild type(APE1WT)mice were randomly divided into experimental group and control group.In vivo CAC model was established by azoxymethane(AOM)and dextran sulfate sodium salt(DSS)solution.Immunohistochemistry(IHC)and multiple IHC(mIHC)assays were used to observe the expression of APE1 and immune cell infiltration in colon tissues of each group.A mouse colon cancer cell line MC38 with stable knockdown of APE1 was constructed by lentivirus transfection,and subcutaneous tumor bearing experiments were performed in APE1WT and APE1C64S mice to confirm that tumor cell-derived APE1 caused immunosuppressive tumor microenvironment.The expression of APE1 and CXCL1[chemokine(C-X-C motif)ligand 1]and the infiltration of immune cells in tumor-bearing specimens were analyzed by IHC and mIHC assays.The tumor specimens of a 28-year-old female patient with CAC from Army Medical Center of PLA were analyzed for the expression of APE1 and CXCL1 and the infiltration of immune cells in the tumor and adjacent inflammatory tissues by IHC and mIHC assays.Results Compared with the control group and APE1WT erperimental group,APE1C64S erperimental group had significantly reduced disease activity index and tumor formation,polymorphonuclear myeloid-derived suppressor cells(PMN-MDSCs)infiltration,and CD4+and CD8+T cells(P＜0.05).No significant differences were observed in tumor growth and immune cells between APE1WT and APE 1C64S mice bearing subcutaneous tumors.However,in the tumor-bearing experiment using tumor cells with knockdown of APE1,the tumor growth was significantly lower and the number of infiltrated PMN-MDSCs was reduced,while those of CD4+and CD8+T cells were significantly increased(P＜0.05).Furthermore,high expression of APE1 and increased infiltration of PMN-MDSCs were found in the tumor tissues of the young CAC patient,and CD8+T cells were significantly reduced in the tumor tissues compared with the inflammatory tissues(P＜0.05).Conclusion APE1-redox in tumor cells can promote the infiltration of PMN-MDSCs and reduce the number of T cells,thereby forming an immunosuppressive tumor microenvironment and mediating the occurrence and development of CAC.

Objective:To explore the effect of case management model based on WeChat on self-care ability and condition status of patients with chronic nephritis.Methods:From January 2020 to February 2022, convenience sampling was used to select 110 patients with chronic nephritis who were treated in the Department of Nephrology, Affiliated Hospital of Jining Medical University. The patients were divided into groups according to the different wards they lived in. The control group consisted of inpatients in the first ward and the research group of inpatients in the second ward, with 55 patients in each group. The control group received routine continuous nursing guidance, while the research group adopted the case management model based on WeChat on the basis of the control group. We compared the self-care ability, negative emotions, and renal function between the two groups.Results:Before nursing, the scores of the Elderly Self-Care Ability Scale (ESCA), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the indicators of renal function [serum creatinine (Scr), blood urea nitrogen (BUN), and 24 hours urine protein (24 h UP) ] were compared between the two groups, and the differences were not statistically significant ( P>0.05). After nursing, ESCA scores such as health knowledge, self-care skills, self-care responsibility, and self-concept in the two groups were higher than those before nursing, and those of the research group were higher than those of the control group, with statistical differences ( t=4.650, 2.250, 3.052, 3.434; all P<0.05). The GAD-7 score and PHQ-9 score of the two groups after nursing were lower than those before nursing, and those of the research group were lower than those of the control group, with statistically significant differences ( t=8.207, 3.464; all P<0.05). After nursing, the renal function indicators such as SCR, BUN, and 24 h UP in the two groups were lower than before nursing, and those of the research group were lower than those of the control group, with statistically significant differences ( t=2.831, 2.797, 2.228; all P<0.05) . Conclusions:Applying the case management model based on WeChat to patients with chronic nephritis can improve their self-care ability, alleviate their negative emotions, promote improvement in their condition.

Objective:To investigate the radiation protection effect of furosemide intervention on 18F-2-deoxy-D-glucose ( 18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging. Methods:A total of 146 patients were randomly divided into two groups, with test group of 74 patients and control group of 72. The test group was administrated orally with furosemide of 40 mg for each one before injection, while the normal control group did not undergo special treatment. 60 and 120 min after 18F-FDG injection, the horizontal measurement of ambient dose equivalent rates was carried out at 0.5 m from the front of both chest and abdomen respectively. Results:For the test group, the ambient dose equivalent rates were measured to be (30.80±8.61) and (41.38±11.06) μSv/h 60 min after injection of 18F-FDG whereas (18.26±4.85) and (24.66±6.50) μSv/h 120 min after injection, respectively, both lower than in the control group and with statistically significant difference between the both ( t =15.36, 13.13, 18.73, 17.29, P<0.05) . No significant difference was found between mediastinal SUV max and liver SUV max in the experimental group and control group ( P>0.05) . Multivariate ANOVA showed that body surface area was a major factor influencing ambient dose equivalent rate regardless of furosemide injection ( t=-13.52, 2.96, P<0.05) , and no obvious effects of age and sex on ambient dose equivalence rate were found. Conclusions:Furosemide intervention can promote urination, effectively reduce the internal radiation exposure of the examinated patietns in the premise of not affecting the image quality, and therefore provide a better radiation protection effect.

OB JECTIVE To study the protective effects of saponins from Gleditsia sinensis on ischemic stroke with phlegm and blood stasis （ISPBS）model rats ，and to explore its mechanism. METHODS Totally 119 rats were randomly divided into normal group （normal saline ），sham operation group （normal saline ），model group （normal saline ），nimodipine group （positive control group ，5 mg/kg），G. sinensis saponin low-dose ，medium-dose and high-dose groups （3.21，6.42 and 12.84 mg/kg），with 17 rats in each group. Except for normal group ，other groups were all given high-fat diet+suture-occluded method to induce ISPBS model. The neurological function score ，water content of brain tissue ，pathological morphology of brain tissue ，the changes of hemorheology indexes （whole blood viscosity ， erythrocyte aggregation index ， Casson-viscosity）， four items of blood lipid [triacylglycerol （TG），total cholesterol （TC），low-density lipoprotein cholesterol （LDL-C），high-density lipoprotein cholesterol（HDL-C）] and inflammatory factors in serum and oxidative stress indexes [malondialdehyde （MDA），nitric oxide （NO），superoxide dismutase （SOD）] in brain tissue were determined or observed in rats. The protein expressions of B lymphocytoma 2（Bcl-2），Bcl-2 associated X protein （Bax）and caspase- 3 in cerebral tissue were also detected. RESULTS Compared with normal group ，the score of nerve function ，5 kinds of serum indexes （TC，TG，LDL-C，TNF-α，IL-1β）， hemorheology indexes ，the contents of MDA and NO and protein expressions of Bax and caspase- 3 in cerebral tissue were all increased significantly in model group （P＜0.01）. The levels of HDL-C and IL- 10 in serum ，SOD activity and protein expression of Bcl- 2 in cerebral tissue were decreased significantly （P＜0.01），and obvious lesions such as nuclear pyknosis and cell membrane fragmentation occurred in brain tissue. Compared with model group ，above indexes of administration groups were improved to different extents ，among which there was statistical significance in above indexes of G. sinensis saponin high-dose group （P＜ 0.01）. CONCLUSIONS Saponin from G. sinensis has a good protective effect on ISPBS model rats. Its mechanism may beassociated with reducing oxidative damage ， reducing the production of pro-inflammatory mediators and resisting neuronal apoptosis.

Objective:To study and analyze the application effect of risk prevention and quality control nursing in peritoneal dialysis patients with renal failure.Methods:From January to December 2019, a total of 86 patients with renal failure in the Affiliated Hospital of Jining Medical College were recruited as the research objects by convenient sampling method. All the objects were divided into the observation group (43 cases) and the control group (43 cases) by the random number table method. The control group was treated with traditional risk prevention and control nursing, while the observation group was treated with risk prevention and control quality control nursing. The changes of albumin, hemoglobin, creatinine, blood urea nitrogen were compared between the two groups before and after intervention, and the incidence of complications such as peritonitis, catheter outlet infection, water retention and hypokalemia were compared between the two groups.Results:After the intervention, the albumin and hemoglobin levels of the observation group were higher than those of the control group, and the levels of creatinine and urea nitrogen in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.01) . During the intervention, the complication rate of the observation group was 23.26% (10/43) , which was lower than 46.51% (20/43) of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:Risk prevention and quality control nursing in peritoneal dialysis patients with renal failure can improve renal function and reduce the occurrence of complications.