Objective To analyze the overall characteristics, research hotspots, and development trends of immune cell-related studies in radiotherapy for rectal cancer. Methods A systematic search was conducted by using Web of Science Core Collection to retrieve articles related to radiation therapy and immune cells in rectal cancer published from 1991 to 2024. Advanced bibliometric tools, such as VOSviewer and CiteSpace, were utilized to facilitate analysis and describe publication trends, geographic contributions, institutional affiliations, journal prominence, author collaboration, and prominent keywords. Results The annual number of relevant publications has increased steadily, showing remarkable growth over the past five years. Studies focusing on adaptive immune cells (T and B cells) account for the largest proportion of works and form the most extensive collaboration networks, reflecting the central role of T cell–mediated antitumor immunity in radiotherapy. Meanwhile, innate immune cells, including myeloid-derived suppressor cells, macrophages, monocytes, and neutrophils, are increasingly investigated for their regulatory roles in shaping the tumor immune microenvironment and influencing therapeutic responses. Among countries, China and the United States have contributed the highest number of publications and demonstrated strong academic influence. While several stable research groups have been formed, intergroup collaboration remains limited. Keyword analysis revealed that radiotherapy-induced immune modulation, tumor immune microenvironment remodeling, and treatment response have emerged as major research hotspots. Conclusion Research on immune cells in rectal cancer radiotherapy has progressed rapidly in recent years. The emphasis of this field has gradually shifted from single-treatment approaches to mechanistic studies investigating the interaction between radiotherapy and the tumor immune microenvironment. The field still demonstrates considerable potential for future research and clinical translational applications.

Objective:To analyze the total amount,institutional flow and development trend of total Traditional Chinese Medicine(TCM)costs in China from 2018 to 2022,and to study the changes of total TCM costs in different primary healthcare institutions.Methods:The total TCM costs were accounted for using the institutional flow method and the case-base aggregation method.Results:From 2018 to 2022,the total TCM costs of primary healthcare organizations in China accounted for a rising proportion,with a stable growth trend,in which the total flow to community and township health centers accounted for a higher proportion,the proportion of total TCM costs of primary institutions in rural areas declined,and there was a negative growth in the village clinics;the growth rate of primary drug costs slowed down,and the growth rate of medical costs showed a wave-like change,with an overall increase in the amount of financial subsidies and subsidies from the higher level.Conclusion:The TCM service capacity of primary healthcare institutions nationwide has been developing steadily,and should continue to expand the existing advantages and build up a solid position for grassroots TCM service in China;the TCM service capacity of China's rural areas still needs to be improved;it is needed to continue to enhance the capacity of primary technical services of Chinese medicine practitioners and rationalizing the role of pharmaceutical services,and the percentage of financial and higher-level subsidies for primary healthcare institutions has been rising fluctuatingly.

Objective To stratify the estrogen receptor(ER)positive while human epidermal growth factor receptor 2(HER2)negative breast cancer patients by the expression level of ER,providing new evidence for prognostic prediction and guiding precision endocrine therapy(ET)for those with different ER expression levels.Methods A retrospective cohort study was conducted on 1 962 ER-positive/HER2-negative breast cancer patients treated in our department from January 1,2013 to December 31,2018.X-tile was used to calculate the optimal cutoff point of ER expression level,and then based on the results,they were divided into low(1%～10%),moderate(11%～30%),and high expression(31%～100%)groups.After propensity score matching(PSM)was performed to balance baseline characteristics,their prognostic outcomes were compared and the responses to ET were analyzed in the groups.Cox proportional risk regression model was applied to analyze the prognostic factors,and subgroup analysis was further performed.Results After PAM,129(11.5%)were assigned into a low ER expression group,151(13.5%)and 840(75%)into moderate and high ER expression groups,respectively.Statistical differences were observed in disease-free survival(DFS)and overall survival(OS)among the 3 groups(P=8e-6,P=8e-14).In the low ER expression group,the patients treated with selective estrogen receptor modulators(SERMs)showed no significant differences in DFS and OS than those treated with aromatase inhibitors(AIs)(P>0.05).However,the patients from the moderate and high ER expression groups demonstrated significantly better DFS when treated with AI than with SERM(P=0.02,P=0.03).Multivariate analysis showed that compared with the moderate ER expression group,the high ER expression group exhibited significantly lower risk of disease recurrence/metastasis(HR=0.62,95%CI:0.43～0.88,P=0.009)and risk of death(HR=0.49,95%CI:0.26～0.93,P=0.03).Subgroup analysis revealed that when compared with the high ER expression group,the moderate ER expression group exhibited notably worse DFS in the following subgroups:oral SERM,non-breast-conserving surgery,lymph node metastasis,TNM stage Ⅱ,and chemotherapy,and shorter OS in the subgroups of oral SERM,non-breast-conserving surgery,lymph node metastasis,TNM stage Ⅱ subgroup,and chemotherapy.Conclusion Taking ER expression of 11%～30%as an independent stratification criterion can guide more accurate prognostic assessment and more rational ET selection in ER-positive/HER2-negative breast cancer patients.

Objective To develop a Self-Management Demand Scale for infertile patients with obese polycystic ovary syndrome(PCOS)suitable for domestic socio-cultural background,and to test its validity and reliability.Methods Based on the self-management model,the item pool of the scale was constructed through literature review,semi-structured interviews,and Delphi expert consultation.Using convenience sampling method,560 obese PCOS combined with infertility patients from a tertiary-level hospital in Wuhan City were selected for questionnaire survey from June to November 2023,and they were divided into 2 parts according to the time of survey for exploratory factor analysis and validation factor analysis.Results Finally,554 valid questionnaires were collected.The Self-Management Demand Scale for infertile patients with obese PCOS contains 3 dimensions and 37 entries.Exploratory factor analysis extracted 3 factors with the cumulative variance contribution rate of 78.785％.The results of the validation factor analysis showed a good model fit.The content validity indices at the scale entry level ranged from 0.830 to 1.000,and the content validity indices at the scale level were 0.920.The Cronbach's αcoefficients for the scale as a whole were 0.967,and those for the dimensions ranged from 0.890 to 0.971;the split-half reliabilities of the overall scale as a whole were 0.856 and the split-half reliabilities of the dimensions were 0.802～0.895.Conclusion The scale has ideal validity and reliability,which provided a scientific tool to measure accurately the self-management demands of the infertile patients with obese PCOS.

Objective:To analyze the total amount,institutional flow and development trend of total Traditional Chinese Medicine(TCM)costs in China from 2018 to 2022,and to study the changes of total TCM costs in different primary healthcare institutions.Methods:The total TCM costs were accounted for using the institutional flow method and the case-base aggregation method.Results:From 2018 to 2022,the total TCM costs of primary healthcare organizations in China accounted for a rising proportion,with a stable growth trend,in which the total flow to community and township health centers accounted for a higher proportion,the proportion of total TCM costs of primary institutions in rural areas declined,and there was a negative growth in the village clinics;the growth rate of primary drug costs slowed down,and the growth rate of medical costs showed a wave-like change,with an overall increase in the amount of financial subsidies and subsidies from the higher level.Conclusion:The TCM service capacity of primary healthcare institutions nationwide has been developing steadily,and should continue to expand the existing advantages and build up a solid position for grassroots TCM service in China;the TCM service capacity of China's rural areas still needs to be improved;it is needed to continue to enhance the capacity of primary technical services of Chinese medicine practitioners and rationalizing the role of pharmaceutical services,and the percentage of financial and higher-level subsidies for primary healthcare institutions has been rising fluctuatingly.

Objective To develop a Self-Management Demand Scale for infertile patients with obese polycystic ovary syndrome(PCOS)suitable for domestic socio-cultural background,and to test its validity and reliability.Methods Based on the self-management model,the item pool of the scale was constructed through literature review,semi-structured interviews,and Delphi expert consultation.Using convenience sampling method,560 obese PCOS combined with infertility patients from a tertiary-level hospital in Wuhan City were selected for questionnaire survey from June to November 2023,and they were divided into 2 parts according to the time of survey for exploratory factor analysis and validation factor analysis.Results Finally,554 valid questionnaires were collected.The Self-Management Demand Scale for infertile patients with obese PCOS contains 3 dimensions and 37 entries.Exploratory factor analysis extracted 3 factors with the cumulative variance contribution rate of 78.785％.The results of the validation factor analysis showed a good model fit.The content validity indices at the scale entry level ranged from 0.830 to 1.000,and the content validity indices at the scale level were 0.920.The Cronbach's αcoefficients for the scale as a whole were 0.967,and those for the dimensions ranged from 0.890 to 0.971;the split-half reliabilities of the overall scale as a whole were 0.856 and the split-half reliabilities of the dimensions were 0.802～0.895.Conclusion The scale has ideal validity and reliability,which provided a scientific tool to measure accurately the self-management demands of the infertile patients with obese PCOS.

This study included 116 professional postgraduate students majoring in clinical surgery who rotated in the Department of Breast and Thyroid Surgery of The First Affiliated Hospital of Army Medical University from 2019 to 2022. The students were provided with open online courses on precision medicine to build a strong theoretical foundation for evidence-based medicine; subsequently, precision medicine courses focusing on thyroid surgery were offered; and multidisciplinary team rounds for typical and difficult-to-diagnose cases were organized. Taking thyroid cancer as an example, questionnaire surveys and typical clinical case assessment were conducted to compare the scientific research and professional competencies of the students before and after evidence-based medicine education. The results showed that the students had significantly improved ability to use academic databases to acquire professional knowledge and solve problems, and showed increased enthusiasm in class, believing that the teaching content was easy to absorb and moderate in difficulty and the teaching effect was good.

Objective:To observe and evaluate the clinical efficacy and safety of albumin-bound paclitaxel as first-line treatment for patients with advanced pancreatic cancer in China, and to explore the prognosis-related molecules in pancreatic cancer based on next-generation sequencing (NGS) of tumor tissues.Methods:From December 2018 to December 2020, patients with locally advanced or metastatic pancreatic cancer were recruited to accept albumin-bound paclitaxel as first-line treatment in the oncology departments of 24 hospitals in East China. The primary endpoints were overall survival (OS) and treatment related adverse events, and the secondary endpoint was progression-free survival (PFS). Adverse effects were graded using Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). NGS sequencing on the primary or metastatic tissue samples of pancreatic cancer obtained through surgical resection or biopsy was performed.Results:This study recruited 229 patients, including 70 patients with locally advanced pancreatic cancer (LAPC) and 159 patients with metastatic pancreatic cancer (mPC). The disease control rate was 79.9% and the objective response rate is 36.3%.The common adverse effects during treatment were anaemia (159 cases), leucopenia (170 cases), neutropenia (169 cases), increased aminotransferases (110 cases), and thrombocytopenia (95 cases), and the incidence of grade 3-4 neutropenia is 12.2% (28/229). The median follow-up time was 21.2 months (95% CI: 18.5-23.1 months). The median PFS (mPFS) was 5.3 months (95% CI: 4.37-4.07 months) and the median OS (mOS) was 11.2 months (95% CI: 9.5-12.9 months). The mPFS of patients with LAPC was 7.4 months (95% CI: 6.6-11.2 months), and their mOS was 15.5 months (95% CI: 12.6-NA months). The mPFS of patients with mPC was 3.9 months (95% CI: 3.4-5.1 months), and their mOS was 9.3 months (95% CI: 8.0-10.8 months). Multivariate Cox regression analysis showed that clinical stage ( HR=1.47, 95% CI: 1.06-2.04), primary tumor site ( HR=0.64, 95% CI: 0.48-0.86), Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ( HR=2.66, 95% CI: 1.53-4.65), and whether to combine radiotherapy ( HR=0.65, 95% CI: 0.42-1.00) were independent influencing factors for the PFS of these patients. The primary tumor site ( HR=0.68, 95% CI: 0.48-0.95), ECOG score ( HR=5.82, 95% CI: 3.14-10.82), and whether to combine radiotherapy ( HR=0.58, 95% CI: 0.35-0.96) were independent influencing factors of the OS of these patients. The most frequent gene mutations in these advanced stage pancreatic patients were KRAS (89.66%), TP53 (77.01%), CDKN2A (32.18%), and SMAD4 (21.84%) by NGS of tumor tissues from 87 pancreatic cancer patients with sufficient specimens. Further analysis revealed that mutations in CDKN2B, PTEN, FGF6, and RBBP8 genes were significantly associated with an increased risk of death ( P＜0.05). Conclusion:Albumin-bound paclitaxel as first-line treatment demonstrated feasible anti-tumor efficacy and manageable safety for patients with advanced pancreatic cancer in China.

Objective:To assess respondents' understanding of the Physical Activity Questionnaire for Chronic Kidney Disease (CKD-PAQ) in Chinese and revise the items.Methods:The CKD-PAQ was sinicized according to the FACIT translation model to form a preliminary version. Using the purposive sampling method, 40 patients with chronic kidney disease from Shenzhen Traditional Chinese Medicine Hospital were selected as respondents for three rounds of cognitive interviews from July to August 2023. Targeted content analysis was used to understand the level of understanding of the initial version of the questionnaire. Based on the respondents' suggestions, the questionnaire's final version was obtained after discussing and negotiating the questionable items.Results:The CKD-PAQ contained four dimensions and 31 items. A total of 22 questions were identified in three rounds of interviews. The results of the first round of interviews show that 13 questions need to be revised in terms of understanding and expression, the results of the second round of interviews show that eight questions need to be revised in terms of understanding and expression, the results of the third round of interviews showed that the language understanding of the revised Chinese version was consistent with the original questionnaire.Conclusions:Cognitive interviews can improve respondents' understanding of the questionnaire and identify issues that are difficult to identify during the localization process, thus improving the accuracy of the questionnaire.

OBJECTIVE To sort out drug prophylaxis regimens for venous thromboembolism （VTE） in adult patients after artificial joint replacement， and provide a basis for clinic. METHODS Databases and related official websites were searched according to the “6S” model， including the National Institute for Health and Clinical Excellence （NICE）， the Scottish Intercollegiate Guidelines Network （SIGN）， the Guidelines International Network （GIN）， the National Guidelines Clearinghouse （NGC）， PubMed， Embase， CNKI， Wanfang database and SinoMed， to search for guidelines， expert consensuses， systematic evaluations， randomized controlled trials， and cohort studies about preventing VTE in adult patients after artificial joint replacement from the inception until December 2023. Literature that met the inclusion criteria were selected， and the quality evaluation of the literature was completed by 2 researchers independently； the evidence rating was performed by using the Joanna Briggs Institute （JBI） evidence pre-classification and evidence rank system （2014 edition）. RESULTS A total of 36 articles were included in the study， which were categorized into 9 areas of risk assessment， post-assessment prophylaxis， medication selection， medication method， duration of medication prophylaxis， medication prophylaxis observation points， contraindications to drug prophylaxis， response to bleeding， and health education， which were summarized to form 37 pieces of evidence on the pharmacological prophylaxis for postoperative VTE in patients who underwent artificial joint replacement. CONCLUSIONS The evidence of drug prophylaxis for postoperative VTE in patients who underwent artificial joint replacement summarized in this study is comprehensive， with certain scientific reference and practicality， which can provide clinical pharmacists with a scientific evidence-based basis for perioperative VTE prophylaxis management.