OBJECTIVE To evaluate the cost-effectiveness of vitamin D analogue for postmenopausal osteoporotic women in China. METHODS A Markov microsimulation model was developed to analyze the clinical and economic outcomes of eldecalcitol， alfacalcidol and calcitriol for postmenopausal osteoporosis from the healthcare system perspective in China. The clinical parameters required for the model were derived from network meta-analysis， while cost and utility data were primarily obtained from the literature. The cycle length was 1 year ， the time horizon was life time， and the willingness-to-pay threshold was 0.5 times the gross domestic product per capita in China in 2023（44 679 yuan/QALY）. Model uncertainty was tested with one-way sensitivity analysis， probabilistic sensitivity analysis， and scenario analysis. RESULTS The quality-adjusted life years （QALYs） for eldecalcitol were calculated to be 12.03 QALYs， which were higher than those for alfacalcidol （11.94 QALYs） and calcitriol （11.92 QALYs）. Meanwhile， the direct medical cost associated with eldecalcitol treatment amounted to 38 805 yuan， which was lower than that of alfacalcidol （45 173 yuan） and calcitriol （45 821 yuan）. The results of the one-way sensitivity analysis showed that the risk ratio of hip fracture and vertebral fracture had a significant impact on the result. The probabilistic sensitivity analysis and scenario analysis showed the robustness of the findings from the base-case analysis. CONCLUSIONS Compared with alfacalcidol and calcitriol， eldecalcitol is likely to be a cost-effective treatment for postmenopausal osteoporotic women in China.

Soil cadmium pollution can adversely affect the cultivation of the ornamental plant, Coleus scutellarioides. Upon cadmium contamination of the soil, the growth of C. scutellarioides is impeded, and it may even succumb to the toxic accumulation of cadmium. In this study, we investigated the effects of arbuscular mycorrhizal fungi (AMF) on the adaptation of C. scutellarioides to cadmium stress, by measuring the physiological metabolism and the degree of root damage of C. scutellarioides, with Aspergillus oryzae as the test fungi. The results indicated that cadmium stress increased the activity of superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT), and the content of malondialdehyde (MDA) and proline (Pro) within the cells of C. scutellarioides, but inhibited mycorrhizal infestation rate, root vigour and growth rate to a great degree. With the same cadmium concentration, the inoculation of AMF significantly improved the physiological indexes of C. scutellarioides. The maximum decrease of MDA content was 42.16%, and the content of secondary metabolites rosemarinic acid and anthocyanosides could be increased by up to 27.43% and 25.72%, respectively. Meanwhile, the increase of root vigour was as high as 35.35%, and the DNA damage of the root system was obviously repaired. In conclusion, the inoculation of AMF can promote the accumulation of secondary metabolites, alleviate root damage, and enhance the tolerance to cadmium stress in C. scutellarioides.
Cadmium/toxicity* ; Mycorrhizae/physiology* ; Plant Roots/drug effects* ; Soil Pollutants/toxicity* ; Stress, Physiological ; Superoxide Dismutase/metabolism*

Human epidermal growth factor receptor 2 (HER2) is a key therapeutic target for breast cancer. With the wide application of anti-HER2 and HER2 antibody-drug conjugates such as trastuzumab, pertuzumab, trastuzumab emtansine, and trastuzumab deruxtecan, the survival of patients with advanced HER2-positive breast cancers have been significantly improved. However, the subsequent drug-induced interstitial lung disease (DILD) has gradually become an important complication affecting the therapeutic effect and safety. However, the clinical understanding of interstitial lung disease (ILD) caused by this type of drugs is still insufficient, the management lacks unified standards, and the molecular mechanism has not been fully clarified. This study, through two clinical cases of severe DILD, explores the pathogenesis, treatment strategies, risk factors and follow-up monitoring requirements of ILD caused by HER2-targeted drugs, providing a scientific basis for optimizing the clinical diagnosis and treatment plan.

Objective To investigate the effect of the rs3765467 polymorphism of glucagon-like peptide-1 receptor(GLP-1R)gene on the efficacy of Liraglutide(Lir)in patients with type 2 diabetes mellitus(T2DM)and metabolic associated fatty liver disease(MAFLD).Methods A total of 281 patients with T2DM from May 2022 to May 2023 were selected,including 125 patients with simple T2DM(T2DM group)and 156 patients with T2DM combined with MAFLD(T2DM+MAFLD group).120 healthy individuals during the same period were selected as the control(NC)group.The related indexes of glucose and lipid metabolism were detected.The polymorphism of GLP-1R gene rs3765467 was detected.Results BMI,FPG,HbA1c,HOMA-IR and TG in each group increased in turn(P<0.05),while the distribution frequency of genotype GG and allele G decreased in turn(P<0.05).TC and LDL-C in T2DM and T2DM+MAFLD groups were higher than those in NC group(P<0.05).TC and TG levels in genotype GA/AA patients were significantly higher than those in genotype GG patients(P<0.05).Compared with before treatment,the levels of BMI,FPG,HbA1c,HOMA-IR,TC,TG and LDL-C in T2DM patients with MAFLD were significantly decreased after Lir treatment(P<0.05).There was no significant difference in BMI and related indexes of glucose and lipid metabolism in GG and GA/AA patients before and after Lir treatment(P>0.05).Conclusions The distribution frequency of GG and G allele at rs3765467 of GLP-1R gene is reduced in T2DM patients with MAFLD.The carrying of allele A was associated with increased TC and TG levels,but did not affect the efficacy of Lir in reducing weight and improving glycolipid metabolism.

Objective Exploring the therapeutic mechanism of Yishen Jiangzhuo Granules(YSJZG)on chronic kidney disease(CKD)based on mitochondrial dynamics and apoptosis of renal tubular epithelial cells.Methods The CKD model of rats with 5/6 nephrectomy was adopted and divided into 6 groups according to random number table:sham operation control group,model group,emodin group(500 mg/kg/d),Yishen Jiangzhuo granule low,middle and high dose groups.After 8 weeks of treatment with YSJZG,serum creatinine(SCR)and urea nitrogen(BUN),pathological changes of renal cortex,mitochondrial morphology and ultrastructure were detected,and mitochondrial kinetic protein in renal tubular epithelial cells was detected by immunohistochemistry(Drp1,Fis1)and fusion proteins(Opa1,Mfn1)were detected by Western blot,and apoptotic proteins(CytC,Bax)in cytoplasm and mitochondria were detected by real-time PCR.Results Renal injury:Compared with the model group,YSJZG groups significantly reduced the levels of SCR and BUN,renal tubular degeneration and necrosis,and mitochondrial structural damage in rats.Renal tubule mitochondrial dynamic protein:Compared with the model group,the expression of division proteins Drp1 and Fis1 was downregulated,the expression of fusion proteins Opa1 and Mfn1 was upregulated,and transmission electron microscopy observed that the mitochondrial fragmentation changes were relatively mild.Apoptosis related indicators and mtDNA copy number of renal tubular cells:Compared with the model group,the content of Bax protein in renal tubular epithelial cells of YSJZG groups increased significantly in cytoplasm(P<0.05)and decreased significantly in mitochondria(P<0.05).The content of CytC protein decreased significantly in cytoplasm(P<0.05)and increased significantly in mitochondria(P<0.05).The copy number of mtDNA increased significantly(P<0.05),and the total levels of SMAC,CytC and Bax mRNA decreased significantly(P<0.05).Correlation between mitochondrial dynamic protein and apoptosis in renal tubular cells:Pearson correlation analysis showed that the expression of Drp1 and Fis1 was negatively correlated with the expression of CytC in mitochondria,and positively correlated with the expression of CytC in cytoplasm.The expression levels of fusion proteins Opa1 and Mfn1 showed a significant positive correlation with CytC expression in mitochondria,and a significant negative correlation with CytC expression in cytoplasm.Conclusion YSJZG can significantly delay the progression of CKD,and its mechanism may be achieved by regulating mitochondrial dynamics of renal tubular epithelial cells,thereby inhibiting endogenous cell apoptosis pathway.

Objective:To investigate and analyze the thyroid examination results and influencing factors of interventional radiation workers in Tianjin.Methods:In February 2023, A convenient sampling method was used to select the staff engaged in interventional radiation work in an occupational health inspection institution in Tianjin from 2020 to 2022 as the study object. After excluding the incomplete data, 1080 people were included, and 363 medical staff with non-radiological work during the same period were included as the control group. To analyze the individual doses and occupational health examination data of interventional radiation workers, and to analyze the possible influencing factors of thyroid abnormalities.Results:The cumulative dose M ( Q1, Q3) of interventional radiation workers was 1.039 (0.528, 1.905) mSv. The levels of FT 3 and FT 4 in the intervention group were higher than those in the control group, while TSH levels were lower than those in the control group ( Z=4.84、6.03、-5.82, P<0.05). The levels of FT 3 and FT 4 in female interventional radiation workers were lower than those in males, while the levels of TSH were higher than those in males ( Z= -17.54、-6.65、3.61, P<0.05). There were statistically significant differences in FT 3 levels among different ages, differen tradiation exposure years, different initial age of exposure to radiation, and different cumulative doses ( H=47.22、11.33、16.70, Z=-2.48, P<0.05). There were statistically significant differences in thyroid ultrasound abnormalities among different genders, different ages, different initial age of exposure to radiation, and different cumulative doses ( χ2=28.02、61.12、17.87、11.30, P<0.05). The results of logistic regression analysis showed that the influencing factors of FT 3 distributed in the low-level group were female ( OR=10.53, 95% CI: 7.66-14.47, P<0.05), and age 40-49, ≥50 years old ( OR=2.40, 95% CI: 1.12-5.14 OR=3.79, 95% CI: 1.59-9.03, P<0.05). The influencing factors of thyroid ultrasound abnormalities were female ( OR=1.92, 95% CI: 1.48-2.50, P<0.05) and age ≥50 years old ( OR=3.93, 95% CI: 1.91-8.09, P<0.05) . Conclusion:Long term low dose ionizing radiation has a certain effect on FT 3, FT 4 and TSH levels of interventional radiation workers. Gender and increased age are possible influencing factors of the decreased FT 3 levels and thyroid ultrasound abnormalities.

The integration of multi-source data and the establishment of early warning indicator systems constitute pivotal elements for advancing surveillance and early warning capacities in respiratory infectious diseases. Given the multifaceted transmission mechanisms and complex contributing factors inherent in respiratory infectious diseases, surveillance datasets and associated early warning indicators demonstrate notable heterogeneity and sophisticated interrelationships. Furthermore, as surveillance and early warning requirements significantly vary across diverse epidemiological scenarios, accurate assessment of the value and applicability of distinct data types and indicators is imperative. This paper systematically reviews and synthesizes recent advancements in surveillance data and early warning indicators for respiratory infectious diseases, drawing on both domestic and international research. Particular attention is dedicated to analyzing the applicability and efficacy of various data types and indicators within multiple practical contexts, aiming to provide robust theoretical frameworks and methodological guidance to facilitate the development of resilient and efficient surveillance and early warning systems for respiratory infectious diseases.

Objective:To compare the clinical characteristics of patients with cryptogenic cirrhosis and hepatitis B cirrhosis in order to provide a basis for the diagnosis of cryptogenic cirrhosis.Methods:A retrospective study was performed. The clinical data of inpatients with cryptogenic cirrhosis from 2010 to 2020 were collected from Peking University First Hospital. The clinical baseline data were analyzed. Patients with hepatitis B cirrhosis hospitalized during the same period were used as the control group, and 1:1 matching was performed according to the age range (±5 years) and the same year of admission. The basic clinical data between the groups were analyzed. The t-test, X2-test or Mann-Whitney U test was used for intergroup comparison.Results:A total of 232 cases with cryptogenic cirrhosis were collected. A total of 207 cases were collected after excluding cases with missing data, including 95 males (45.9%) and 112 females (54.1%), with a median age of 66 (57-76) years. A total of 182 pairs were matched according to the matching criteria for the control study. Compared with the hepatitis B cirrhosis group, the patients with cryptogenic cirrhosis had higher blood triglycerides (0.89 mmol/L vs. 0.80 mmol/L, P=0.002)and total cholesterol (3.73 mmol/L vs. 3.55 mmol/L, P=0.048), alanine transaminase (21.0 U/L vs. 24.5 U/L, P=0.003) and aspartate transaminase (29.5 U/L vs. 33.0 U/L, P=0.008) were lower, the prothrombin time was shorter (12.4 s vs. 13.0 s, P=0.003), and the INR was lower (1.18 vs. 1.21, P=0.015) with statistically significant differences ( P<0.05). The proportion of patients with cryptogenic cirrhosis combined with hepatocellular carcinoma (15.9% vs. 35.7%, P<0.001), hepatic encephalopathy (2.7% vs. 7.7%, P=0.034), and hepatorenal syndrome (1.6% vs. 5.5%, P=0.048),were relatively low, and the differences were statistically significant ( P<0.05). Conclusions:Cryptogenic cirrhosis at our hospital may be associated with metabolic syndrome and cannot be excluded as a cause of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in some of these patients.

ObjectiveTo investigate the impact of preoperative frailty on the prognosis of patients with pancreatic cancer who underwent pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 435 pancreatic cancer patients who underwent pancreaticoduodenectomy at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Preoperative frailty was assessed using the FRAIL questionnaire. Binary logistics regression analysis was employed to identify factors influencing frailty， and Cox regression analysis was used to evaluate the effect of frailty on survival. According to the demographic characteristics， subgroup analyses were performed on the effect of frailty on prognosis of patients with pancreatic cancer with pancreaticoduodenectomy. ResultsAmong the 435 patients enrolled， 119 （27.4%） exhibited frailty， while 316 （72.6%） did not. Significant differences were observed between the two groups in various clinical parameters， including age， body mass index， American Society of Anesthesiologists （ASA） score， postoperative red blood cell transfusion， postoperative abdominal abscess， serum levels of glycoantigens 199， glycoantigens 125， and alpha fetoprotein， leukocyte count， neutrophil， high density lipoprotein （HDL） level， and pain intensity （P＜0.05）. Advanced age and an ASA score of Ⅲ were identified as risk factors for frailty， whereas HDL level was a protective factor. Non-frail patients had better postoperative survival times than frail patients. HDL was determined to be an independent protective factor for prognosis， while LDL was an independent risk factor. ConclusionsThis study demonstrates that preoperative frailty is a significant predictor of poor prognosis in pancreatic cancer patients who underwent pancreaticoduodenectomy.These findings suggest that preoperative frailty assessment and targeted interventions to improve nutritional and metabolic status could potentially enhance postoperative survival and quality of life in pancreatic cancer patients.

Objective:To study the epidemic characteristics and clinical symptoms of patients with Hashimoto's thyroiditis (HT) in Shandong Province, and to provide a basis for further optimizing the clinical treatment strategies for HT.Methods:Data on HT patients admitted to Shandong Provincial Center for Disease Control and Prevention from January 2018 to December 2023 were collected. A retrospective analysis was conducted to analyze their epidemiological characteristics, clinical symptoms, and auxiliary examination results.Results:A total of 192 HT patients' data were included, comprising 42 males (21.87%) and 150 females (78.13%). The average age of patients was 40.38 years old, ranging from 9 to 74 years old. Most patients resided in urban areas (129 cases, 67.19%). HT cases occurred throughout the year in every mouth, with higher incidence in June (32 cases, 16.7%) and July (20 cases, 10.4%), lower incidence in March (8 cases, 4.2%) and April (10 cases, 5.2%), and sporadic cases in other months. Based on clinical manifestations, among all HT patients, there were 66 cases (34.38%) of Hashitoxicosis type, 11 cases (5.73%) of pseudothyrotoxicosis type, 7 cases (3.65%) of exophthalmic type, 5 cases (2.60%) of subacute thyroiditis-like type, 3 cases (1.56%) of juvenile type, 35 cases (18.23%) of fibrous type, 39 cases (20.31%) of thyroid adenoma or carcinoma type, and 26 cases (13.54%) of other autoimmune diseases type. Based on disease progression, among all HT patients, there were 61 cases (31.77%) in the hyperthyroid phase, 16 cases (8.33%) in the hyperthyroid-hypothyroid coexisting phase, and 115 cases (59.90%) in the hypothyroid phase. Based on clinical symptoms, among all HT patients,there were 78 cases(40.62%) of neck mass symptoms, 101 cases (52.60%) of digestive system symptoms, and 95 cases (49.48%) of low metabolic symptoms. Laboratory tests revealed that 144 cases had elevated levels of both thyroglobulin antibody and thyroid peroxidase antibody. Color ultrasound examination showed strip-like echoes in the thyroid in 99 cases (51.56%) and grid-like echoes in 43 cases (22.40%). After treatment with antithyroid drugs or appropriate thyroid hormone supplementation, all 192 HT patients experienced symptom relief.Conclusions:HT patients in Shandong Province were predominantly female and urban residents. Common clinical symptoms included anterior neck swelling, constipation, fever, and weight gain. Early detection, diagnosis, and treatment could delay disease progression.