OBJECTIVE To evaluate the cost-effectiveness of datopotamab deruxtecan versus traditional chemotherapy as first-line treatment for advanced triple-negative breast cancer （TNBC） in patients ineligible for immunotherapy， from the perspective of the health system in China.METHODS A partitioned survival model was constructed based on the results of the TROPION-Breast02 study. The time horizon was set at 10 years with a cycle length of 21 d， a discount rate of 4.5%， and a willingness-to-pay （WTP） threshold of 2 times the per capita gross domestic product （GDP） of China in 2025. The incremental cost-effectiveness ratio （ICER） of datopotamab deruxtecan versus chemotherapy was calculated. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. Scenario analyses of price reductions of datopotamab deruxtecan were also conducted to estimate the required price reduction magnitude and prices for the ICER to fall below the WTP thresholds of 2， 1 and 0.5 times the per capita GDP of China.RESULTS Compared with chemotherapy， datopotamab deruxtecan could yield an additional 0.37 quality-adjusted life year （QALY）， with an ICER of 825 725.04 yuan/QALY， which was higher than the WTP threshold （199 330 yuan/QALY）. One-way sensitivity analysis indicated that the ICER was highly sensitive to the cost of datopotamab deruxtecan and sacituzumab govitecan （for subsequent treatment）， and the utility value of the progression-free survival state； the results of both one-way and probabilistic sensitivity analyses supported the good robustness of the model. The scenario analyses showed that when the price of datopotamab deruxtecan was reduced by 36.30%， 42.08% and 44.96%， respectively （corresponding to prices of 4 246.18， 3 861.15 and 3 668.66 yuan per 100 mg）， the ICER fell below the WTP thresholds of 2， 1 and 0.5 times the per capita GDP of China， respectively.CONCLUSIONS At a WTP threshold of 2 times the per capita GDP of China in 2025， datopotamab deruxtecan as first-line treatment for advanced TNBC in patients ineligible for immunotherapy is not cost-effective compared with chemotherapy.

Objective To translate the Maternal Childbirth Fatigue Perception Questionnaire(MCFQ)into Chinese and examine its reliability and validity among women undergoing vaginal deliv-ery.Methods Following the Brislin translation model,the MCFQ was translated,back-translated,culturally adapted and pre-tested to develop a Chinese version.By using the convenience sampling method,574 parturients were selected for a questionnaire survey from January to April 2024,and the reliability and validity of the Chinese questionnaire were evaluated.Results The Chinese version of MCFQ consisted of 3 dimensions and 13 items,namely physical fatigue(7 items),perceived fatigue(3 items)and emotional fatigue(3 items).The item-level content validity index ranged from0.813 to 1.000,and the scale-level content validity index was 0.938.The overall Cronbach's α coefficient of the scale was 0.870,and the split-half reliability coefficient was 0.848.Confirmatory factor analysis demonstrated that the question naire had a good fit.Conclusion The Chinese version of MCFQ has good reliability and validity and can be used as an effective tool to assess the fatigue level of parturients during the delivery process.It is helpful for clinical medical staff to optimize the management of the la-bor process,improve the quality of delivery,and ensure the safety of mothers and infants.

Traditional Chinese medicine(TCM)is an ancient medical system distinctive and effective in treating cancer,depression,coronavirus disease 2019(COVID-19),and other diseases.However,the relatively abstract diagnostic methods of TCM lack objective measurement,and the complex mechanisms of action are difficult to comprehend,which hinders the application and internationalization of TCM.Recently,while breakthroughs have been made in utilizing methods such as network pharmacology and virtual screening for TCM research,the rise of machine learning(ML)has significantly enhanced their inte-gration with TCM.This article introduces representative methodological cases in quality control,mechanism research,diagnosis,and treatment processes of TCM,revealing the potential applications of ML technology in TCM.Furthermore,the challenges faced by ML in TCM applications are summarized,and future directions are discussed.

Colorectal inflammatory cancer transformation poses a major risk to patients with colitis.Patients with chronic intestinal inflammation have an approximately 2-3 fold increased risk of developing colorectal cancer(CRC).Unfortunately,there is currently no effective intervention available.Huangqin decoction(HQD),a well-known traditional Chinese medicine(TCM)formula,is frequently clinically prescribed for treating patients with colitis,and its active ingredients have effective antitumour efficacy.Nonetheless,the mechanism of HQD-mediated prevention of colorectal inflammatory cancer transformation remains unclear.A strategy integrating metagenomic,lipidomic,and messenger RNA(mRNA)sequencing analysis was used to investigate the regulatory effects of HQD on the gut microbiome,metabolism and potential mechanisms involved in colorectal inflammatory cancer transformation.Our study revealed that HQD suppressed colorectal inflammatory cancer transformation,which was associated with enhanced in-testinal barrier function,decreased the inflammatory response,and regulation of the gut microbiome.Notably,cohousing experiments revealed that the transfer of the gut microbiome from HQD-treated mice largely inhibited the pathological transformation of colitis.Moreover,gut microbiome transfer from HQD-treated mice primarily resulted in the altered regulation of fatty acid metabolism,especially the remodeling of arachidonic acid metabolism,which was associated with the amelioration of pathological transformation.Arachidonic acid metabolism and the key metabolic enzyme arachidonic acid 12-lipoxygenase(ALOX12)were affected by HQD treatment,and no obvious protective effect of HQD was observed in Alox12-/-mice,which revealed that ALOX12 was a critical mediator of HQD protection against colorectal inflammatory cancer transformation.In summary,multiple omics analyses were applied to produce valuable data and theoretical support for the application of HQD as a promising intervention for the transformation of inflammatory CRC.

Objective To conduct a scoping review of the application of gamification programs in exercise rehabilitation for knee osteoarthritis,examining the application carriers,game content,outcome indicators,measurement tools,and application effects of gamification programs,to provide references for future practice and related research in this field.Methods The search was conducted in PubMed,Web of Science,Cochrane Library,Scopus,CIN AHL,China National Knowledge Infrastructure,CNKI,and Wanfang Data from their inception to December 28,2024.The included studies were summarized and analyzed.Results A total of 28 studies were included in the review.The game carriers encompassed virtual reality technology,sensor devices,and mobile applications.The game content covered interactive motion games,aerobic exercises,and goal-motivated games.Outcome indicators included functional performance,physical activity,pain,psychological and health status,and user experience.Gamification programs were found to effectively enhance user engagement,improve physical function,reduce negative emotions,and improve quality of life.However,there remains controversy regarding their efficacy in pain relief.Conclusion Gamification programs have shown positive effects in exercise rehabilitation for knee osteoarthritis.Future efforts should focus on developing gamification programs that are culturally appropriate for China,creating"digital therapeutics",continuously updating systems,conducting economic evaluations,and ensuring digital equity to enhance patients'rehabilitation experiences and improve health outcomes.

With the development of science and technology worldwide, the blooming of artificial intelligence (AI) and big data has brought new opportunities and challenges to the promotion of the research capacity of professional master's students in oncology. The construction of the new medical education in China aims to cultivate high-level medical talents with comprehensive multidisciplinary skills and innovative abilities to flexibly solve complex problems at the frontier of medicine. In this context, professional master's students in oncology, who are facing problems such as low scientific research output and uneven quality and needing improving scientific research literacy, have been required to develop into compound talents with both clinical and research prowess. To cultivate and promote the research capacity of professional master's students in oncology, the key steps include accelerating the construction of AI education and databases, highlighting the cultivation of their scientific research capacity, implementing and fostering the cultivation of innovative ability and scientific research thinking, piloting joint cultivation models by engineering universities and medical universities, emphasizing the construction of the curriculum and teacher team for oncology, piloting the multidisciplinary mode and COME mode, and establishing a multidisciplinary cooperation network.

Objective:To explore the construction of a core competency evaluation indicator system for pediatric surgery operating room specialist nurses.Methods:The evaluation indicator system was constructed by reviewing literature, analyzing semi-structured interview results, and examining the characteristics of training specialized nurses in pediatric surgery operating rooms, as well as combining the characteristics of pediatric surgery and multi-source data. The research group discussed and proposed a preliminary core competency evaluation indicator system for specialized nurses in pediatric surgery operating rooms. This study used the Delphi expert inquiry method to conduct two rounds of expert consultation and ultimately established the core competency evaluation indicator system for pediatric surgery operating room specialist nurses. The expert positivity coefficient was represented by the questionnaire response rate, and the expert authority coefficient was calculated using the judgment coefficient and familiarity degree. The coefficient of variation and Kendall's W coefficient were used to measure the degree of coordination of expert opinions. Results:The effective response rates for the two rounds of expert consultation were 100.00% and 95.24%, respectively. The authority coefficients of the two rounds of expert consultation were 0.92 and 0.90, respectively. The coefficients of variation of indicators at various levels were less than 0.25. The Kendall's W coefficients for the first-, second-, and third-level indicators in the first and second rounds of expert consultation were 0.516-0.664 and 0.652-0.711, respectively ( P<0.001). The final core competency evaluation indicator system for pediatric surgery operating room specialist nurses included 3 first-level indicators, 15 second-level indicators, and 52 third-level indicators. Conclusions:The core competency evaluation indicator system for pediatric surgery operating room specialist nurses constructed in this study provides a scientific and practical guidance for training pediatric surgery operating room specialist nurses in China.

Objective:To investigate the clinicopathological characteristics of lung transplantation and post-transplantation changes in patients with pneumoconiosis.Methods:A retrospective study was conducted to analyze the clinical and pathological data of 28 patients with pulmonary silicosis who underwent lung transplantation and were managed at the Department of Internal Medicine, Henan Provincial People′s Hospital, Zhengzhou, China from January 2015 to December 2024. Among them, 8 patients underwent lung biopsy 6-20 months after transplantation to evaluate the histopathological changes of the recipient and the donor lungs post-transplantation. The expression of relevant indicators was examined using immunohistochemical EnVision staining, while presence of microorganisms was assessed using histochemical special staining. The patients were all followed up.Results:Among the 28 patients with pneumoconiosis who underwent lung transplantation, 26 were male and 2 were female, with a male-to-female ratio of 13∶1. Their ages ranged from 23 to 68 years, median 50.0 (46.0, 53.5) years. They were diagnosed with pneumoconiosis at local occupational disease prevention and control centers for 3 to 15 years (mean, 9.65 years), including 13 left single lung transplants and 15 right single lung transplants. Gross examination showed fleshy nodules with irregular cystic cavities at the periphery. The cut surfaces exhibited gray-brown color and firm texture. Microscopically, most alveolar structures of the lung were obliterated, with nodular or diffuse proliferation of collagen fibers accompanied by hyaline degeneration. Focal massive carbon dust deposition and massive silicotic fibrosis were observed, surrounded by lung parenchyma with emphysematous changes and localized bullae formation. Seven patients underwent re-biopsy after transplantation that showed extensive infiltration of inflammatory cells. In 4 cases, microscopy revealed complete coagulative necrosis, with negative acid-fast staining and TB-DNA results. Of the 4 cases, 3 cases exhibited Aspergillus infection confirmed by Grocott′s methenamine silver and PAS stains, while 2 cases showed chronic bronchitis with squamous metaplasia. Follow-up revealed that 8 patients died of acute respiratory failure due to severe infection, while the remaining 20 demonstrated significant postoperative improvement in lung function.Conclusions:For patients with advanced pulmonary dust deposition disease who undergo lung transplantation, it is necessary to conduct standardized sampling and pathological assessment of the recipient lungs. In the early post-transplant period, the complications of re-biopsy tissues are mainly fungal infections. The combination of morphological manifestations and immunohistochemical detection is helpful to distinguish infection from rejection reactions. At the same time, it is essential to integrate clinical information and laboratory results to provide post-transplantation pathological assessment for individualized treatment.

Multimorbidity has become a widely recognized public health problem worldwide. Identifying multimorbidity patterns can improve not only the efficiency of healthcare resource utilization but also patients' prognosis. This article summarizes three common approaches for the identification of multimorbidity patterns: association analysis methods (including association rule mining and network analysis), classification methods (including cluster analysis, latent class analysis, and latent transition analysis), and dimensionality reduction and feature extraction methods (including principal component analysis, factor analysis, and multiple correspondence analysis), introduces the application of these methods using data from the UK Biobank to identify multimorbidity patterns and discusses and compares the results of case analysis to provide reference for the selection of appropriate methods for multimorbidity pattern research.

Hypervirulent Klebsiella pneumoniae(hvKP)is a highly pathogenic pathogen that is more virulent than classic Klebsiella pneumoniae(cKP)and often leads to severe disseminated infections.The horizontal transfer of virulence plasmids and carbapenem-resistant genes in hvKP through plasmids and mobile genetic elements(MG-Es)has led to the emergence of carbapenem-resistant(CR)-hvKP,posing a serious threat to public health.A deep understanding of the epidemiological characteristics,pathogenic mechanisms and convergence of virulence and drug resistance in hvKP is crucial for preventing and monitoring infections caused by this bacterium.