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.

OBJECTIVE To evaluate the cost-effectiveness of amivantamab combined with lazertinib （hereinafter referred to as “AL”） regimen as first-line treatment for EGFR -mutated advanced non-small cell lung cancer （NSCLC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was established based on updated data from the MARIPOSA study， with a 10-year time horizon and 28-day cycles. The primary outcome index was quality adjusted life year （QALY）， and the willingness-to-pay （WTP） threshold was set at three times China’s per capita GDP in 2024 （287 247 yuan/QALY）. Cost-utility analysis was used to calculate the incremental cost-effectiveness ratio （ICER） of AL regimen versus osimertinib monotherapy regimen as first-line treatment for EGFR -mutated advanced NSCLC. One-way and probabilistic sensitivity analyses were performed to test model robustness. Scena rio analyses were conducted to explore the impact of utility values for different health states on the outcomes and determine the required price reductions of amivantamab and lazertinib to achieve cost-effectiveness. RESULTS Compared with the osimertinib monotherapy regimen， the ICER for the AL regimen as first-line treatment for advanced EGFR -mutated NSCLC was 2 062 096.15 yuan/QALY， significantly exceeding the WTP threshold established in this study. One-way sensitivity analysis revealed that the utility value of progression-free survival state and the price of amivantamab were the primary factors influencing the ICER. Probabilistic sensitivity analysis revealed that the AL regimen only became cost-effective when the WTP threshold was set at 2 050 000 yuan/QALY. Scenario analysis indicated that altering the utility value still rendered the AL regimen non-cost-effective. When amivantamab （350 mg） prices decreased by 80%， 85%， and 90% respectively， lazertinib （80 mg） prices would need to decrease by 95.97%， 40.63%， 5.29%， respectively. This would enable the AL regimen’s ICER to consistently fall within the WTP threshold established in this study. CONCLUSIONS At the WTP threshold established in this study， the AL regimen does not demonstrate cost-effectiveness for first-line treatment of advanced EGFR -mutated NSCLC compared to the osimertinib monotherapy regimen. Significant price reductions for both drugs would be required to alleviate the financial burden on patients.

OBJECTIVE To evaluate the cost-effectiveness of culmerciclib combined with fulvestrant as second-line treatment for patients with hormone receptor-positive（HR+）/human epidermal growth factor receptor 2-negative （HER2–） locally advanced or metastatic breast cancer， within the context of the Chinese healthcare system. METHODS A partitioned survival model was established based on the CULMATE-1 study， with a simulation time horizon set at 15 years and a cycle length of 28 days. The incremental cost-effectiveness ratio （ICER） of culmerciclib combined with fulvestrant versus fulvestrant monotherapy as second-line treatment for HR+/HER2– breast cancer was calculated. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. Meanwhile， scenario analysis of culmerciclib price reduction was conducted； the required price reduction and price to reach the willingness-to-pay （WTP） threshold in this study were calculated. RESULTS The results of the base-case analysis indicated that， compared with the fulvestrant monotherapy regimen， culmerciclib combined with fulvestrant yielded an additional 0.823 quality-adjusted life year （QALY）， with a corresponding ICER of 371 696.26 yuan/QALY， which exceeded the WTP threshold （199 330 yuan/QALY）. The results of the univariate sensitivity analysis indicated that the cost of culmerciclib， the discount rate， the utility values for progression disease and progression free survival status were significant factors influencing the ICER； both the univariate sensitivity analysis and the probabilistic sensitivity analysis validated the robustness of the model results. Scenario analysis indicated that when the price of culmerciclib was reduced by 30%， 55% and 85% respectively， the corresponding ICER values fell below 3， 2， and 1 times China’s per capita GDP in 2025， with the probability of cost-effectiveness being 3.00%， 94.90%， 100%. When the cost of culmerciclib （60 mg） was reduced by 52.6% to 50.96 yuan， the ICER value met the WTP threshold established in this study. CONCLUSIONS When the WTP threshold is set at twice China’s per capita GDP in 2025， second-line treatment with culmerciclib combined with fulvestrant for HR+/HER2– locally advanced or metastatic breast cancer does not exhibit cost-effectiveness advantage over fulvestrant monotherapy. Therefore， a reasonable price reduction is required to alleviate the financial burden on patients.

Objective:To analyze the clinical characteristics and cytokines expression characteristics in infants with mild and severe respiratory syncytial virus (RSV) infection.Methods:From May 2023 to December 2023, plasma samples and clinical information were collected from 16 infants with RSV infection and 14 control infants. Cytek Aurora flow cytometry (Cytek, America) and Enzyme linked immunosorbent assay (ELISA) were used to detect the expression levels of 25 cytokines after mild and severe RSV infection.Results:Cough and nasal obstruction were the main clinical manifestations in infants with mild RSV infection, accompanied by polypnea, wheezing and other symptoms. The main symptoms of severe RSV infection were cough and rales, accompanied by fever and polypnea. In comparison with the control group, the expression levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-13, IL-22, TNF-α, IFN-α, IFN-β, MIP-1β, I-TAC, ENA-78, GROα, Eotaxin, and MCP-1 in the RSV infection group all exhibited an upregulation trend. Both IP-10 and MIP-3α demonstrated a downward trend in the RSV infection group; however, there was no statistically significant difference ( P>0.05). The levels of IL-10, IFN-γ, MIP-1α, and IL-8 in the RSV infection group were significantly higher than those in the control group, whereas the levels of MIG, TARC, and RANTES in the RSV infection group were significantly lower than those in the control group ( P<0.05). The levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-22, IFN-β, IFN-γ, TNF-α, IL-8, I-TAC, MIP-1β, Eotaxin, and MCP-1 in the mild RSV infection group were significantly higher than those in the severe RSV infection group ( P>0.05). Among these, the levels of MIG, RANTES, TARC, MIP-3α, and ENA-78 in the mild infection group were all lower than those in the severe infection group. The expressions of ENA-78 and MIP-1α in the severe infection group were significantly higher than those in the mild infection group and also higher than those in the control group. There was no significant difference in IP-10 and GROα between the mild and severe RSV infection groups ( P>0.05). Conclusions:The differences in clinical features and cytokines between infants with mild and severe RSV infection provide important data support for the prevention and treatment of RSV infection in infants.

Objective To evaluate the cost-effectiveness of inclisiran injection treatment in patients with atherosclerotic heart disease(ASCVD)in China.Methods From the perspective of China's health system,according to the Markov model,patients with ASCVD were divided into inclisilan injection group and placebo group,and both groups were treated with convention-al lipid-lowering drugs.The study period was 25 years.The rate parameters,cost parameters,and effectiveness parameters were de-rived from the ORION-18 trial and other literature.Effects were expressed as quality-adjusted life-years(QALYs).The incremental cost-effectiveness ratio(ICER)was used to evaluate the economy of inclisilan injection.One-way sensitivity analysis and probabil-ity sensitivity analysis were used to verify the reliability of the results.Results The treatment effect of the inclisilan injection group was higher(10.02 QALYs),and the cost of the placebo group was lower(255 179 yuan).The ICER of the two groups was 137 850 yuan per QALY gained,and using 257 094 yuan per capita by 2022 as the threshold,the treatment would be economically advantageous.Sensitivity analysis supported this result.Conclusion At present,the additional use of inclisilan injection can get a better treatment effect,and it has economic advantages under the threshold of three times GDP per capita in China.

OBJECTIVE To evaluate the cost-effectiveness of sacituzumab tirumotecan （ST） versus chemotherapy treatment physician’s choice （TPC） as second-line and later-line treatment for metastatic triple-negative breast cancer （mTNBC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was constructed based on the OptiTROP-Breast 01 trial， with a cycle length of 4 weeks and a time horizon of 10 years， applying a 5% discount rate. Quality adjusted life year （QALY） and costs were used as outcome measures， and the incremental cost-effectiveness ratio （ICER） of ST versus TPC for second-line and later-line treatment of mTNBC was calculated. Sensitivity analyses were conducted to validate the robustness of the base-case results. RESULTS At a willingness-to-pay threshold （WTP） of 3 times China’s 2024 per capita gross domestic product （GDP） （287 247 yuan/QALY）， patients receiving ST gained incremental utility （0.42 QALY） at a higher cost， yielding an ICER of 205 562.07 yuan/QALY， which was lower than WTP， indicating that ST was more cost-effective compared to TPC. One-way sensitivity analysis revealed that key factors influencing the ICER included the utility value of progression-free survival and the price of ST. Probabilistic sensitivity analysis and scenario analysis showed that the base-case results were robust. CONCLUSIONS From the perspective of China’s healthcare system， at a WTP of 3 times China’s per capita GDP， ST is more cost-effective than TPC as second-line and later-line treatment for mTNBC.

AIM:To observe the effect of dexme-detomidine(DEX)on cerebral ischemia and reperfu-sion(I/R)injury and investigate the possible mecha-nism of nuclear factor erythroid derived 2-like 2(Nrf2)mediated ferroptosis on hippocampal neu-rons.METHODS:The oxygen glucose deprivation/reoxygenation(OGD/R)model in rat primary cul-tured hippocampal neurons was simulated,DEX(50 μmol/L)and Nrf inhibitor BRU(100 nmol/L)were used to observe the changes of ROS levels by DHE fluorescence probe.The middle cerebral ar-tery occlusion model in male SD rats were estab-lished,the degree of neurological impairment was detected by Longa score,and cerebral infarct size was detected by TTC staining.The Fe2+concentra-tion and levels of oxidative stress related factors were detected,oxidative stress and ferroptosis re-lated protein expressions were detected by West-ern blot.RESULTS:The fluorescence intensity of DHE in OGD/R+Dex Group was lower than that in CON group,and the fluorescence intensity of DHE in OGD/R+DEX+BRU group was higher than that in OGD/R+Dex group.Compared with Sham group,the Longa score and cerebral infarct size in I/R group were significantly increased(P＜0.01),the lev-els of SOD,CAT,GSH and GSH-PX were significantly decreased.MDA and Fe2+concentrations were in-creased,the protein expressions of Nrf2,HO-1,GPX4,FTH1 and FPN1 were decreased,and TFR1 protein expression was increased.Compared with I/R group,in DEX+I/R group,the Longa score and ce-rebral infarct size were decreased(P＜0.01),the lev-els of SOD,CAT,GSH and GSH-PX were increased.MDA and Fe2+concentrations were decreased,the protein expressions of Nrf2,HO-1,GPX4,FTH1 and FPN1 were increased,and TFR1 protein expression was decreased.The Nrf2 inhibitor Bru reversed the role of DEX.CONCLUSION:DEX protects against ce-rebral I/R injury through activating Nrf2 signaling pathway and inhibiting ferroptosis in hippocampal neurons.

Objective To evaluate the cost-effectiveness of deucravacitinib in the treatment of moderate to severe plaque psoriasis from the perspective of the Chinese health system.Methods Based on POETYK PSO-1 study and related cost and utility data,a decision tree combined with Markov model was established.The model period was 10 years,and the output indicators of the model were cost and quality-adjusted life year(QALY).The evaluation index of the model was the incremental cost-effectiveness ratio(ICER).The willingness-to-pay threshold(WTP)was 3 times of China's per capita GDP in 2023.Sensitivity analysis was performed to evaluate the robustness of the model results.Results The incremental utility and incremental cost were 0.598QALYs and 130 677.51 yuan(RMB),respectively.The ICER of the two strategies was 218 487.11 yuan(RMB)per QALY gained,which was less than 3 times GDP per capita in 2023.Sensitivity analyses confirmed the robustness of the model.Conclusion Under the threshold of 3 times the GDP per capita in China,deucravacitinib is cost-effective in the treatment of moderate to severe plaque psoriasis.

Objective:To analyze the effect of exercise intervention based on the transtheoretical model on sedentary time and exercise adherence in elderly patients with stroke.Methods:A convenience sample of 60 elderly patients with stroke who visited Fuyang Hospital Affiliated to Anhui Medical University and were registered in community health records between December 2023 and August 2024 was recruited. Participants were randomly assigned to the intervention group ( n=30) and control group ( n=30). The intervention lasted 28 weeks. The control group received standardized home-based exercise program, while the intervention group received exercise intervention based on the transtheoretical model. Sedentary time, exercise adherence, and exercise self-efficacy were assessed before intervention, at week 16, and at week 28. Results:A total of 28 participants in each group completed the study. Sedentary time in the intervention group showed a continuous downward trend over the intervention period and was significantly lower than that in the control group at weeks 16 and 28 ( P<0.05). Exercise adherence in the intervention group was significantly higher at week 28 ( P<0.001). Exercise self-efficacy was significantly higher at week 16 and further improved at week 28 compared with the control group ( P<0.05) . Conclusions:An exercise intervention program designed based on the transtheoretical model can effectively reduce sedentary time, improve exercise adherence, and enhance exercise self-efficacy in elderly patients with stroke.

Objective:To analyze the effect of exercise intervention based on the transtheoretical model on sedentary time and exercise adherence in elderly patients with stroke.Methods:A convenience sample of 60 elderly patients with stroke who visited Fuyang Hospital Affiliated to Anhui Medical University and were registered in community health records between December 2023 and August 2024 was recruited. Participants were randomly assigned to the intervention group ( n=30) and control group ( n=30). The intervention lasted 28 weeks. The control group received standardized home-based exercise program, while the intervention group received exercise intervention based on the transtheoretical model. Sedentary time, exercise adherence, and exercise self-efficacy were assessed before intervention, at week 16, and at week 28. Results:A total of 28 participants in each group completed the study. Sedentary time in the intervention group showed a continuous downward trend over the intervention period and was significantly lower than that in the control group at weeks 16 and 28 ( P<0.05). Exercise adherence in the intervention group was significantly higher at week 28 ( P<0.001). Exercise self-efficacy was significantly higher at week 16 and further improved at week 28 compared with the control group ( P<0.05) . Conclusions:An exercise intervention program designed based on the transtheoretical model can effectively reduce sedentary time, improve exercise adherence, and enhance exercise self-efficacy in elderly patients with stroke.