OBJECTIVE To provide direction and reference for the adjustment of the discount rate （DR） in China’s pharmacoeconomic guidelines. METHODS Search was conducted on the official websites of the International Society for Pharmacoeconomics and Outcomes Research， health technology assessment agencies in various countries/regions， as well as relevant websites of other upper-middle-income or high-income countries/regions. The recommended DR， adjustment trends， and setting rationales in pharmacoeconomic evaluation guidelines across different countries/regions were then summarized and compared. Based on theoretical derivation and literature analysis， the effects of different DR on the incremental cost-effectiveness ratio （ICER） were examined. RESULTS & CONCLUSIONS Among the 40 included guidelines， the base-case DR ranged from 1.5% to 5%， with 5% being the most common value； the range for sensitivity analysis was 0 to 12%. Thirty-six countries/regions applied the same DR to both costs and health outcomes， while in the Netherlands， Belgium， Poland and Czech Republic， DR for costs was higher than for health outcomes. In recent years， Korea， France and Ireland had lowered their DR in response to economic changes， whereas the Netherlands and Czech Republic had raised their DR for cost. The setting of the DR was primarily based on the public project investment interest rate or referred to recommendations from internationally authoritative institutions and other relevant guidelines. The direction and magnitude of the impact of different DR on the ICER largely depended on the distribution of costs and health outcomes between the intervention and reference measure. The setting and adjustment of DR were closely associated with the economic environment. Based on international experience, the DR in China can be lowered by 0.5% to 1.5%， and localized empirical research can be conducted using internationally common estimation methods.

Objective: To examine the association between incidence of hand-foot-mouth disease (HFMD) and meteorological factors, so as to provide the basis for the prevention and control of HFMD. Methods: The number of HFMD cases in Jiading District, Shanghai Municipality from 2016 to 2023 were collected through the Chinese Disease Prevention and Control Information System, and meteorological data were obtained from the Shanghai Meteorological Bureau. The associations of daily average temperature, daily average relative humidity, and daily average atmospheric pressure with the daily number of HFMD cases were analyzed using a distributed lag non-linear model (DLNM). Results: A total of 21 555 HFMD cases were reported in Jiading District from 2016 to 2023, with an average annual incidence of 132.57/100 000. There were 12 762 male cases (59.21%) and 8 793 female cases (40.79%). The main peak of incidence occurred from June to August, and the secondary peak was from October to December. DLNM analysis showed that the incidence risk of HFMD first increased and then decreased with the increase of daily average temperature, and first decreased and then increased with the prolongation of the lag time. The cumulative lag risk was higher when the daily average temperature ranged from 18.4 to 35.1 ℃, and the maximum cumulative lag effect was observed at 27.8 ℃ (RR=5.522, 95%CI: 4.751-6.370). The incidence risk of HFMD first increased and then decreased with the increase of daily average relative humidity, and first decreased, then increased and then decreased again with the prolongation of the lag time. The cumulative lag risk was higher when the daily average relative humidity ranged from 71.7% and 90.8%, and the maximum cumulative lag effect was observed at 81.8% (RR=1.603, 95%CI: 1.321-1.995). The incidence risk of HFMD decreased with the increase of daily average atmospheric pressure, and decreased with the prolongation of the lag time when the daily average atmospheric pressure was greater than 1 015.80 hPa. When the daily average atmospheric pressure was less than 1 015.80 hPa, the incidence risk of HFMD increased with the prolongation of the lag time. The maximum cumulative lag effect was observed at 986.80 hPa (RR=8.513, 95%CI: 1.401-36.625). Conclusion The incidence risk of HFMD in Jiading District initially increases and then decreases with increasing temperature and relative humidity, while it decreases with increasing atmospheric pressure, and these effects exhibit a lagged response.

Objective:To determine the content of the released nickel ion through the 7 extraction media to extract the Ni-Ti wires and to plot the curve of the released nickel ion so as to identify a leaching medium that can be substituted for blood for in vitro Ni release evaluation. Methods:The release of Ni through microwave digestion/inductively coupled plasma mass spectrometry (ICP-MS) in the goat serum was determined. Because of the high content of Ni release, it could be determined by diluting the extraction medium, and other extraction media could be determined directly. Ni release standard curves were plotted by the release amount and different time point variables. Though the different extraction media Ni release curves confirm the specificity of extraction media instead of blood.Results:By analyzing the Ni release curves of seven leaching media, it was found that none of these seven extraction media was suitable for the evaluation of Ni release in in vitro leaching media. Considering the safety of the leaching medium and the simplicity of preparation, hydrochloric acid solution was chosen as the leaching medium, but the concentration needed to be diluted accordingly. Finally, a hydrochloric acid solution was created as an alternative to blood for the in vitro study of Ni release from Ni-Ti alloy cardiovascular products, with a volume fraction of 0.005%. Conclusions:The in vitro leaching medium that can replace blood was found to be hydrochloric acid for the time being, but its concentration was too high, resulting in too much Ni release as well, which deviated from the actual situation. Therefore, the hydrochloric acid solution was diluted step by step, and the Ni release curve was examined until it was close to the clinical release level, and the actual concentration was determined, thus laying a solid foundation for the subsequent evaluation of the safety and risk.

To analyze the epidemiological characteristics of acute respiratory infections (ARIs) during the autumn-winter season in Beijing, providing evidence for the prevention, control, diagnosis, and treatment of ARIs.

Objective:To establish a scoring system for preoperative prediction of the malignant potential of gastric stromal tumors based on gastroscopic and endoscopic ultrasound features, along with validation.Methods:A total of 286 patients who were treated in Jiangsu Province Hospital of Chinese Medicine from January 1, 2017 to December 31, 2023 and diagnosed as having gastric stromal tumors by postoperative pathology were enrolled in the modeling group. According to National Institutes of Health classification system, 227 very-low/low-risk patients were classified into the low malignant potential (LMP) group, and the 59 intermediate/high-risk patients into the high malignant potential (HMP) group. LASSO regression analysis was performed to identify predictive factors for HMP gastric stromal tumors, and a nomogram prediction model was developed. Internal validation using the Bootstrap method was performed on the modeling group, and external validation was performed on data from 85 patients who were treated and diagnosed as having gastric stromal tumors by postoperative pathology in Taizhou People's Hospital from January 1, 2021 to December 31, 2023. The receiver operator characteristic (ROC) curves, calibration curves, and decision curve analyses were employed in both the modeling and external validation groups.Results:Tumor size (coef=0.755), tumor shape (coef=0.015), tumor location (coef=0.008), growth pattern (coef=-0.026), cystic change (coef=0.685), and surface unceration change (coef=-0.545) were the independent predictive factors for HMP gastric stromal tumors. The nomogram-based prediction model constructed using these factors achieved an area under the ROC curve of 0.959 (95% CI: 0.898-0.903) in the modeling group and 0.959 (95% CI: 0.857-1.000) in the external validation group. The model demonstrated good accuracy (0.917) and a Kappa value of 0.737 in internal validation. Calibration curve and decision curve analyses indicated strong calibration and high net benefit in both the modeling and the external validation groups. Conclusion:Tumor size, tumor shape, tumor location, growth pattern, cystic change, and surface ulceration change are independent predictive factors for HMP gastric stromal tumors. The nomogram model developed based on these factors offers effective and convenient visualization for clinicians to predict the malignant potential of gastric stromal tumors preoperatively.

Objective:To summarize the clinical characteristics of newly-developed lesions of early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD) , and to investigate the risk factors associated with metachronous multiple primary early esophageal cancers.Methods:A retrospective analysis was conducted on clinical data and postoperative follow-up results of 311 patients who underwent esophageal ESD at the Department of Gastroenterology, Taizhou People's Hospital, from January 2018 to January 2020. The incidence and interval of newly-developed lesions were documented, and the risk factors for metachronous multiple primary esophageal cancers were identified.Results:Among the 311 patients, 1 case (0.3%) experienced local recurrence, 2 patients (0.6%) had synchronous multiple primary early esophageal cancers, and 27 cases (8.7%) had metachronous multiple primary early esophageal cancers. Multivariate regression analysis showed that lesion length ( OR=5.728, 95% CI: 0.959-34.208, P<0.001), Lugol-voiding lesions (LVLs) with speckled distribution ( OR=6.574, 95% CI: 2.163-19.977, P<0.001), and high neutrophil-to-lymphocyte ratio (NLR) ( OR=3.72, 95% CI: 2.144-6.452, P<0.001) were independent risk factors for metachronous multiple primary early esophageal cancers. Conclusion:Incidence of metachronous multiple primary early esophageal cancers is elevated in patients with long lesions, LVLs exhibiting speckled distribution, and high NLR. Therefore, close follow-up is essential for patients displaying these identified risk factors.

Objective:To explore the clinical warning value of ischemic modified albumin (IMA) and IMA to human serum albumin (HSA) ratio (IMAR) in the development of pre-eclampsia (PE) and its severity.Methods:A total of 156 pregnant women with PE admitted to the Haidian District Maternal and Child Health Hospital of Beijing from April 2022 to March 2023 were collected as the PE group, and 156 healthy pregnant women with the same age and gestational age were matched as the control group. PE pregnant women were further divided into severe PE group (78 cases) and non-severe PE group (78 cases). Severe PE pregnant women were divided into emergency group (42 cases) and non-emergency group (36 cases) according to the disease progression time.All pregnant women were stratified according to their HSA levels (<30 g/L, 30-32 g/L, ≥32 g/L), and the peripheral blood IMA, HSA, and IMAR of pregnant women in different periods and subgroups were compared, and also the difference of IMA levels in umbilical artery blood. Bivariate correlation analysis was used to explore the correlation between severe PE and IMA or IMAR, and receiver operating characteristic (ROC) curves was used to analyze the diagnostic value of IMA, HSA, and IMAR for PE and severe PE.Results:(1) The IMA level and IMAR in peripheral serum of pregnant women in the PE group at diagnosis, and the IMA level in umbilical artery blood at delivery, and peripheral serum at 2 days after delivery were higher than those in the control group. The HSA level in peripheral serum was lower than that in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (2) The IMA level and IMAR in the peripheral serum of pregnant women with severe PE were higher than those in the non-severe PE group at diagnosis, while the HSA level were lower than those in the non-severe PE group. The differences were statistically significant (all P<0.05). At diagnosis, the IMA level and IMAR in peripheral serum of pregnant women in the emergency group were higher than those in the non-emergency group, while the HSA level was lower than that in the non-emergency group. The differences were statistically significant (all P<0.05). When diagnosed, the peripheral serum IMA levels of pregnant women in the PE group were compared between subgroups with HSA<30 g/L, 30-32 g/L, ≥32 g/L, and there was no statistically significant difference ( F=0.366, P=0.694). However, the IMAR was compared between the three subgroups, and the difference was statistically significant ( F=28.544, P<0.001), which increased with the decrease of HSA levels. In the subgroup with HSA≥32 g/L, the peripheral serum IMA level and IMAR of pregnant women in the PE group were higher than those in the control group at diagnosis, and the differences were statistically significant (all P<0.001). (3) The severe PE manifestations positively correlated with peripheral serum IMAR at diagnosis include systolic blood pressure ( r=0.279), mean arterial pressure ( r=0.212), and urinary protein quantification ( r=0.277), while the severe PE manifestations negatively correlated include HSA levels ( r=-0.644) and newborn birth weight ( r=-0.305), all of which were significantly correlated ( P<0.05). (4) The area under curve (AUC) for IMAR diagnosis of PE was 0.875 (95% CI: 0.833-0.916), with the highest diagnostic efficiency at a cutoff value of 2.06, sensitivity of 72.5%, and specificity of 85.1%. The AUC for diagnosing severe PE was 0.871 (95% CI: 0.822-0.919), with the highest diagnostic efficacy at a cutoff value of 2.18, sensitivity of 72.3%, and specificity of 88.3%. The diagnostic efficacy of IMAR for PE and severe PE were higher than those of IMA and HSA levels. Conclusions:The level of IMA and IMAR in pregnant women with PE are higher than those in normal pregnant women. IMA and IMAR are correlated with the severity of PE, with IMAR changes occurring earlier and more significantly. IMAR could be considered as one of the evaluation indicators for the development of PE, or as a more sensitive PE severity warning indicator than HSA.

Objective:To measure the beam stability of the electron FLASH radiotherapy accelerator developed by the Institute of Applied Electronics of Chinese Academy of Engineering Physics and to evaluate the performance of scintillator, fast current sensor (FCT) and graphite under the electron FLASH beam.Methods:Each continuous beam exit deviation and each pulse deviation at the electron FLASH radiotherapy accelerator in the same working state were measured. The correlation among three monitors and the measured dose of the accelerator at different electron beam energy (controlled by changing the charging voltage) and different beam pulse numbers were compared, which were validated by a Monte Carlo simulation procedure.Results:At the first high pressure, the first 10 scintillators and FCT signals were relatively large, approximately 2% deviation compared with the average value of 400 pulses. Among 40 beam outflows, the deviation between each pulse was within ±5%. In the accelerator steady state, each beam outflow deviation was within ±1%. Both simulated and measured values showed that the monitor could not be used for dose monitoring at different electron beam energy. However, when the energy was the same, only the number of beam pulses was changed, and linear relationship was observed between the number of the three monitors and the dose measured by the film (all R 2 > 0.999). Conclusions:The beam deviation of each beam outflow of this electron FLASH accelerator is within ±1%. Under the stability of the accelerator beam, the scintillator, FCT and graphite can meet the dose monitoring of the target area, which can provide reference for dose monitoring for subsequent biological experiments.

As a common clinical disease, fracture is often accompanied by pain, swelling, bleeding as well as other symptoms and has a high disability rate, even threatening life, seriously endangering patients' physical and psychological health and quality of life. Medical practitioners take many strategies for the treatment of fracture healing, including Traditional Chinese Medicine (TCM). In the early stage of fracture healing, the local fracture is often in a state of hypoxia, accompanied by the expression of hypoxia inducible factor-1α (HIF-1α), which is beneficial to wound healing. Through literature mining, we thought that hypoxia, HIF-1α and downstream factors affected the mechanism of fracture healing, as well as dominated this process. Therefore, we reviewed the local characteristics and related signaling pathways involved in the fracture healing process and summarized the intervention of TCM on these mechanisms, in order to inspirit the new strategy for fracture healing, as well as elaborate on the possible principles of TCM in treating fractures based on the HIF molecular mechanism.

BACKGROUND:In clinical application,simple interspinous fixation without additional interbody fusion has similar fixation effects to pedicle screw and rod fusion internal fixation,and can effectively reduce the range of motion of the responsible segment and the stress of the articular process.However,after simple placement of the new interspinous fusion fixation device BacFuse,the stress at the root of the spinous process is relatively concentrated,and the spinous fracture is prone to occur.If an intervertebral fusion cage is inserted in conjunction with interspinous fixation,Von Mises stress can theoretically be dispersed to reduce the risk of spinous fracture.However,there are few studies on biomechanics and finite element analysis. OBJECTIVE:To observe the biomechanical stability of interspinous fixation-assisted endoscopic interbody fusion in the treatment of severe lumbar spinal stenosis. METHODS:The normal finite element model M0 of the L4-L5 segment of the lumbar spine was established by Mimics,Geomagic,Solidworks,and ANSYS software based on the lumbar CT images of a 26-year-old adult male volunteer excluding spinal diseases.On the basis of M0,the immediate model M1 after endoscopic decompression combined with interbody fusion,the interspinous fixation device(BacFuse)model M2 after endoscopic decompression,and the interspinous fixation(BacFuse)model M3 after endoscopic-assisted interbody fusion were established.The same stress was applied to the upper surface of the L4 vertebral body in the four groups,and the lower surface of the L5 vertebral body was fixed and supported.The range of motion and the extreme Von Mises stress of the endplate bone and the posterior ligament complex of the vertebral body were analyzed under six working conditions of flexion,extension,left/right bending,and left/right rotation. RESULTS AND CONCLUSION:(1)Compared with model M0,the range of motion value of model M1 increased significantly under six working conditions.Model M2 and model M3 had a significant reduction in range of motion.(2)Compared with model M0,the maximum stress of the vertebral body in model M1 did not change significantly under the six working conditions.The maximum stress at the rear of the M2 vertebral body increased significantly.(3)Compared with model M1,the maximum stress of model M3 did not change significantly under the six working conditions.Compared with model M2,the maximum stress of model M3 decreased significantly.(4)Compared with the model M0,the extreme Von Mises stress of the L4 and L5 endplates of the model M1 was significantly increased.The extreme Von Mises stress in L4 and L5 endplates of models M2 and M3 decreased slightly.Compared with model M1,the Von Mises stress of the bone under the L4 and L5 endplate of models M2 and M3 was significantly reduced.(5)It is concluded that the implantation of BacFuse can effectively reduce the bone stress under the endplate during simple interbody fusion,decrease the risk of cage subsidence,diminish the risk of facet joint fracture on the decompression side,and provide a good stable environment for interbody fusion.The placement of an intervertebral fusion cage can reduce the stress of the root of the spinous process,which is beneficial to decrease the risk of fracture of the root of the spinous process.