OBJECTIVE To evaluate the cost-effectiveness of cefiderocol versus best available therapy （BAT） or standard-of- care （SOC） for the treatment of confirmed or suspected carbapenem-resistant Gram-negative bacterial （CRGNB） serious infections from the perspective of the Chinese healthcare system， and to explore its reasonable pricing. METHODS A decision tree model was constructed based on data from two phase Ⅲ clinical trials （CREDIBLE-CR and GAME CHANGER） to simulate the cost- effectiveness of cefiderocol in two scenarios： salvage therapy for confirmed CRGNB infection （scenario 1） and empirical therapy for suspected CRGNB infection （scenario 2）. The primary outcome measure was the incremental cost-effectiveness ratio （ICER）. The willingness-to-pay （WTP） was set at 1 to 3 times China’s per capita GDP in 2024. To verify the robustness of the results， one- way and probabilistic sensitivity analyses were conducted， and based on these， a reasonable price range for cefiderocol in the Chinese market was explored. RESULTS The results for scenario 1 showed that the clinical cure rate in the cefiderocol group was higher than that in the BAT group （47.50% vs. 34.21%）， but its ICER was 415 065.03 yuan per cured case， exceeding three times China’s GDP per capita. Scenario 2 revealed that the ICER for cefiderocol relative to SOC was as high as 1 362 446.16 yuan per cured case， far exceeding the WTP. Sensitivity analysis indicated that the treatment duration and price of cefiderocol were key factors affecting its cost-effectiveness. In the two scenarios described above， the unit price of cefiderocol must fall below 683.47 and 242.00 yuan/g， respectively， to be considered cost-effective. CONCLUSIONS Based on the current market price， cefiderocol lacks sufficient cost-effectiveness for treating confirmed or suspected CRGNB serious infections within China’s healthcare system. To improve its accessibility， price negotiations or a tiered medical insurance payment strategy are required.

OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of serplulimab as a first-line treatment of small- cell lung cancer （SCLC）， and provide an evidence-based basis for drug selection in hospitals. METHODS Rapid health technology assessment was adopted； PubMed， Cochrane Library， Embase， CNKI， Wanfang， VIP and official websites of domestic and international health technology assessment agencies were systematically searched from the inception to Oct. 2024. Two reviewers independently screened the literature， assessed the quality of included studies and carried out the qualitative analysis according to the inclusion and exclusion criteria. RESULTS A total of 13 systematic reviews/meta-analyses and 9 economic studies were included， and the literature quality was generally good. In terms of effectiveness， compared with chemotherapy alone， serplulimab combined with chemotherapy significantly improved progression-free survival， overall survival， and objective response rate in patients with SCLC. In terms of safety， serplulimab combined with chemotherapy showed no significant difference in the incidence of ≥3 grade adverse events compared with chemotherapy alone in the treatment of SCLC， indicating a good safety profile； compared with combination therapies involving other immunosuppressive agents， the incidence rate of adverse events was also lower. In terms of cost-effectiveness， compared with chemotherapy alone， serplulimab combined with chemotherapy is not cost- effective， which may be related to the high price of serplulimab. CONCLUSIONS Serplulimab is effective and safe in the treatment of SCLC， but has no obvious advantage in terms of cost-effectiveness.

OBJECTIVE To evaluate the cost-utiliby of capivasertib combined with fulvestrant for the second-line treatment of hormone receptor-positive/human epidermal growth factor receptor-2-negative （HR+/HER2－） advanced breast cancer from the perspective of the Chinese healthcare system. METHODS A partitioned survival model was constructed using clinical data from the CAPItello-291 trial. Costs and quality-adjusted life years （QALYs） were used as the output indicators of the model， and the incremental cost-effectiveness ratio （ICER） was used as the evaluation indicator of the model. Using three times the per capita gross domestic product （GDP） of China in 2024 as the willingness-to-pay threshold （WTP）， this study analyzed the cost-utility of capivasertib combined with fulvestrant versus fulvestrant monotherapy in the treatment of HR+/HER2－ advanced breast cancer， and conducted sensitivity analysis and scenario analysis under conditions where the price of capivasertib was reduced by 50%， 60%， 70% and 95%， respectively. RESULTS The results of the basic analysis showed that compared with the fulvestrant monotherapy regimen， the ICER of capivasertib combined with fulvestrant was 843 038.46 yuan/QALY， which was higher than the WTP（287 247 yuan/QALY）. The one-way sensitivity analysis revealed that the top three factors with the most substantial influence on ICER were the utility value in the progression disease state， the price of capivasertib， and the utility value inthe progression free survival state. Probabilistic sensitivity analysis demonstrated the robustness of the basic analysis results. Scenario analysis revealed that even if the price of capivasertib were reduced by 95%， capivasertib combined with fulvestrant did not exhibit cost-effectiveness at the current WTP. CONCLUSION At a WTP of three times China’s GDP per capita in 2024， compared to fulvestrant monotherapy， capivasertib combined with fulvestrant as the second-line treatment for HR+/ HER2－ advanced breast cancer is not cost-effective.

For the treatment of vertebral metastases,percutaneous vertebral augmentation can effectively relieve pain,stabilize vertebrae,and prevent and treat pathological fractures.Bone cement leakage is the most common complication of percutaneous vertebral augmentation.Most bone cement leakages are asymptomatic and no special management is required,but close attention should be paid to some rare and serious complications caused by bone cement leakage.This paper aims to make a comprehensive review about the advances in percutaneous vertebral augmentation for vertebral metastases,focusing on the technical features,characteristics of bone cement,types of bone cement leakage,leakage-related factors and their preventive measures,etc.

Objective To investigate the short-term efficacy of CT-guided microwave ablation(MWA)combined with percutaneous vertebroplasty(PVP)for spinal metastases,and to analyze the risk factors for postoperative cement leakage.Methods The clinical data of 50 patients with spinal metastases(74 diseased vertebrae in total),who were treated with CT-guided MW A combined with PVP at the authors'hospital from January 2020 to June 2023,were retrospectively analyzed.Numerical Pain Rating Scale(NRS),daily morphine consumption(DMC)and Activity of Daily Living Scale(ADL)were used to evaluate the short-term efficacy.Regular postoperative CT reexamination was carried out to assess the condition of local tumor control and bone cement leakage.Univariate analysis and multivariate binary logistic analysis of gender,age,maximum diameter of metastatic lesion,type of metastasis,Tomita classification of primary tumor,level of affected vertebrae,injected volume of bone cement,injection side,pathological fracture,and posterior vertebral wall rupture were performed to determine the risk factors for postoperative occurrence of bone cement leakage.Results The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month NRS were(7.24±1.41),(4.76±1.45),(3.42±1.34),(2.86±0.90),(2.20±0.57),(1.66±0.72)points respectively.The preoperative,and the postoperative one-day,one-week,one-month,3-month and 6-month DMC were(110.40±94.61),(66.10±51.23),(47.30±37.49),(32.90±22.84),(25.60±18.97),(15.36±13.43)mg respectively.The preoperative,and the postoperative one-week,one-month,3-month and 6-month ADL were(40.80±11.45),(53.20±6.68),(60.40±5.14),(62.90±4.75),(64.80±4.51)points respectively.The differences in NRS,DMC,ADL between their preoperative values and postoperative 6-month values were statistically significant(all P＜0.05).Postoperative 6-month imaging follow-up check revealed that tumor was controlled in 46 patients and the tumor recurrence rate was 8％(4/50),and mild bone cement leakage occurred in 17 of 74 vertebrae(22.97％).Multivariate regression analysis indicated that pathological fracture(OR=9.581,95％CI=2.292-40.055,P=0.002)and rupture of posterior wall of vertebra(OR=5.105,95％CI=1.041-25.022,P=0.044)were the independent risk factors for bone cement leakage,the pathological fracture(OR=35.333,95％CI=4.029-309.840,P=0.001)was the independent risk factor for cortical bone cement leakage.No independent risk factor for vascular bone cement leakage was observed.The rupture of posterior wall of vertebra(OR=48.400,95％CI=4.725-495.753,P=0.001)was the independent risk factor for leakage of bone cement in spinal canal.Conclusion MW A combined with PVP can rapidly relieve pain,improve the ability of daily activity and quality of life of patients with spinal metastases,which can be further improved within 6 months after treatment.The combination use of MW A and PVP carries lower incidence of bone cement leakage.The pathological fracture and posterior wall rupture of vertebra are the independent risk factors for bone cement leakage.

Colorectal cancer(CRC)is one of the most common malignant tumors worldwide,metastasizing most commonly to the liver and lung.Local treatment of pulmonary oligometastases from CRC has an important position in the therapeutic course of the disease,sometimes local therapy is the key to achieve a disease-free state.Surgery is the preferred treatment for pulmonary oligometastases from CRC,but some patients are unable to undergo surgery due to physical conditions or lesion's anatomical location limitations.Because of its minimally-invasive manipulation,repeatable adoption,maximum preservation of lung parenchyma and lung function,and the potential to cure new or recurrent lung metastases,percutaneous ablation therapy has emerged as an important surgical alternative,and its clinical application has been increasing in recent years.Percutaneous ablation techniques mainly include radiofrequency ablation(RFA),microwave ablation(MWA),and cryoablation(CA).RFA produces thermal effect through high-frequency electrical current,and it is easy to operate and applicable for a wide range of treatments.MW A uses efficient microwave heating technique and its energy distribution is uniform,suitable for larger lesions.Through repeated freeze-thaw cycles CA destroys tumor tissues,which is particularly suitable for the lesions near important structures.Besides,percutaneous ablation combined with surgery,medication,etc.can be used for the treatment of pulmonary oligometastases from CRC,this kind of combination therapy has synergistic effect to enhance the curative efficacy.This paper aims to make a comprehensive review about the importance of treating pulmonary oligometastases from CRC,the efficacy,prognosis,and influencing factors of various percutaneous ablation techniques,and the application progress of ablation combined with other therapies.

Background::In vitro fertilization (IVF) has emerged as a transformative solution for infertility. However, achieving favorable live-birth outcomes remains challenging. Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods, including static images and temporal videos. However, traditional embryo selection methods, primarily reliant on visual inspection of morphology, exhibit variability and are contingent on the experience of practitioners. Therefore, an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable. Methods::We employed artificial intelligence (AI) for embryo morphological grading, blastocyst embryo selection, aneuploidy prediction, and final live-birth outcome prediction. We developed and validated the AI models using multitask learning for embryo morphological assessment, including pronucleus type on day 1 and the number of blastomeres, asymmetry, and fragmentation of blastomeres on day 3, using 19,201 embryo photographs from 8271 patients. A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5, and predict live-birth outcomes. Additionally, a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing (PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes.Results::These two approaches enabled us to automatically assess the implantation potential. By combining embryo and maternal metrics in an ensemble AI model, we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists (46.1% vs. 30.7% on day 3, 55.0% vs. 40.7% on day 5). Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians (area under the curve: 0.769, 95% confidence interval: 0.709–0.820). These findings could potentially provide a noninvasive, high-throughput, and low-cost screening tool to facilitate embryo selection and achieve better outcomes. Conclusions::Our study underscores the AI model’s ability to provide interpretable evidence for clinicians in assisted reproduction, highlighting its potential as a noninvasive, efficient, and cost-effective tool for improved embryo selection and enhanced IVF outcomes. The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.

Objective:To construct a nomogram model for predicting stress urinary incontinence (SUI) in young and middle-aged women.Methods:Using a sampling survey method, 1 000 questionnaires were distributed to young and middle-aged women in 2 streets of Urumqi community from May 2021 to October 2023 to investigate their basic situation, lifestyle habits and gynecological related information. The International Urinary Incontinence Advisory Committee urinary incontinence questionnaire was used to diagnose SUI, and the patients were divided into SUI group and control group based on the results. Seven hundred and eighty-six questionnaires were collected. The survey results of the two groups were analyzed, and a nomogram model for predicting the occurrence of SUI in young and middle-aged women was constructed and validated.Results:Among the 786 young and middle-aged women, there were 147 cases in the SUI group and 639 cases in the control group. The age, body mass index (BMI), and the incidences of diabetes, chronic constipation, delivery history, macrosomia delivery history, pelvic floor dysfunction in SUI group were significantly higher than those in control group: (44.51 ± 8.20) years vs. (38.60 ± 12.35) years, (27.31 ± 4.53) kg/m 2 vs. (24.28 ± 4.38) kg/m 2, 13.61% (20/147) vs. 3.44% (22/639), 19.05% (28/147) vs. 5.01% (32/639), 90.48% (133/147) vs. 75.90% (485/639), 17.01% (25/147) vs. 3.44% (22/639) and 11.56% (17/147) vs. 3.29% (21/639), and there were statistical differences ( P<0.01). Multivariate Logistic regression analysis result showed that age>44 years, BMI≥30 kg/m 2, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction were independent risk factors for SUI in young and middle-aged women ( RR = 1.511, 2.543, 4.636, 4.293, 2.526, 6.220 and 5.834; 95% CI 1.007 to 2.268, 1.661 to 3.894, 2.281 to 9.422, 2.339 to 7.881, 1.374 to 4.643, 3.205 to 12.071 and 2.641 to 12.888; P<0.05 or <0.01). The age, BMI, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction were used as predictors to construct a nomogram model for predicting the SUI in young and middle-aged women. The 550 cases were randomly selected from the dataset as the training set and the remaining 236 cases as the validation set. The receiver operating characteristic curve was drawn, and the result showed that the area under the training set curve was 0.818 (95% CI 0.773 to 0.862), and the area under the validation set curve was 0.826 (95% CI 0.764 to 0.889); the Hosmer-Lemeshow goodness of fit test in validation set that result showed that the nomogram model had high reliability ( χ2 = 8.48, P>0.05). Conclusions:The incidence of SUI in young and middle-aged women is high. The age >44 years, BMI≥30 kg/m 2, diabetes, chronic constipation, delivery history, macrosomia delivery history and pelvic floor dysfunction are independent risk factors for SUI in young and middle-aged women. The nomogram model based on related risk factors has high predictive value and credibility.

Nuclear receptor corepressor (NCoR1) interacts with various nuclear receptors and regulates the anabolism and catabolism of lipids. An imbalance in lipid/energy homeostasis is also an important factor in obesity and metabolic syndrome development. In this study, we found that the deletion of NCoR1 in intestinal epithelial cells (IECs) mainly activated the nuclear receptor PPARα and attenuated metabolic syndrome by stimulating thermogenesis. The increase in brown adipose tissue thermogenesis was mediated by gut-derived tricarboxylic acid cycle intermediate succinate, whose production was significantly enhanced by PPARα activation in the fed state. Additionally, NCoR1 deletion derepressed intestinal LXR, increased cholesterol excretion, and impaired duodenal lipid absorption by decreasing bile acid hydrophobicity, thereby reversing the possible negative effects of intestinal PPARα activation. Therefore, the simultaneous regulatory effect of intestinal NCoR1 on both lipid intake and energy expenditure strongly suggests that it is a promising target for developing metabolic syndrome treatment.

Objective:To investigate the current situation of occurrence of social isolation in maintenance hemodialysis patients and analyze its influencing factors, in order to provide a theoretical basis for the implementation of targeted interventions.Methods:The study was a cross-sectional study. A total of 315 dialysis patients in three hemodialysis centers in Xinjiang were selected by simple sampling method from October 2021 to March 2022, who were investigated using the general information questionnaire, Lubben-6 social network scale, International Physical Activity Questionnaire (sedentary behavior section), Patient Health Questionnaire 9-item scale (PHQ-9) and Frail Scale. Univariate analysis and binary Logistic regression analysis were used to explore the influencing factors affecting the social isolation of dialysis patients.Results:Social isolation was present in 28.89% (91/315) of maintenance hemodialysis patients, and binary Logistic regression analysis revealed that age (45-59 years old: OR=4.815, 95% CI 1.362-17.017;≥60 years old: OR=8.968, 95% CI 2.349-34.236), dialysis age ( OR=2.788, 95% CI 1.334-5.826), sedentary behavior ( OR=2.504, 95% CI 1.406-4.461), depression ( OR=2.095, 95% CI 1.179-3.722), and debilitation ( OR=2.043, 95% CI=1.062-3.933) were influencing factors of social isolation in maintenance hemodialysis patients (all P<0.05). Conclusions:The occurrence of social isolation in maintenance hemodialysis patients was closely associated with advanced age, high dialysis age, sedentary behavior, debilitation, and depressive status, suggesting that medical staff in hemodialysis centers can implement targeted interventions to prevent or improve the level of social isolation in patients based on relevant influencing factors.