OBJECTIVE To establish a hospital preparation cost item library， providing a reference for the refined accounting management of preparation costs in medical institutions. METHODS Based on literature analysis and practical work experience， a preliminary list of cost items was drafted. The Delphi method was employed to screen and optimize the items by analyzing the questionnaire recovery rate， expert authority coefficient， item importance score， coefficient of variation， and Kendall’s W of concordance. RESULTS The questionnaire recovery rates for the two rounds of expert consultation were 95.7% and 100%， respectively； the expert authority coefficients were 0.937 and 0.939， respectively； Kendall’s W of concordance were statistically significant （ P ＜0.001）. The finally established hospital preparation cost item library included 6 first-level items （such as raw material and packaging material costs， human resource costs， and production operation costs） and 29 second-level items （including main drug raw material costs， production personnel compensation， and finished product full-item testing costs）， comprehensively covering dimensions such as raw materials and packaging materials， fixed asset depreciation and equipment maintenance， human resources， production operations， energy and environment， and R & D and other costs. CONCLUSIONS This study successfully establishes a scientific and reliable cost item library for medical institution preparations， which can guide institutions to itemize actual expenditures， provide structured evidence for autonomous pricing， and support data needs for the formulation of insurance access and payment policies for innovative preparations.

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 investigate the effects of chronic restraint stress for 28 days(day and night)on mood and cognitive-like behavior in male and female ICR mice,to provide a basis for the selection of sex and restraint period in chronic restraint stress model animals.Methods A total of 72 male and female(1∶1)ICR mice were divided into six groups:male control,daytime restraint,and nighttime restraint groups,and female control,daytime restraint,and nighttime restraint groups.Mice in all but the control groups were bound for 10 h/d and restrained continuously for 28 days to establish a chronic restraint stress model.The emotional and cognitive behaviors induced by restraint in male and female mice at different times were observed by open field,Y maze,novel inhibition feeding,elevated cross maze,tail suspension,forced swimming,and dark-avoidance experiments.Results In the tail suspension experiment,the immobility time of male mice in the daytime restraint group was significantly increased compared with that in the control group(P＜0.05),and the immobility times of male mice in the daytime and nighttime restraint groups were also significantly increased in the forced swimming experiment,compared with those in the control group(P＜0.05).There was no significant difference between the female daytime restraint and female control groups in the novelty inhibition feeding experiment,but the feeding latency of the nighttime restraint group was significantly longer than that of the control group(P＜0.05)and the daytime restraint group(P＜0.05).The feeding latency of female mice was significantly longer than that of males during nighttime restraint(P＜0.05).In the open field test,compared with the male control group,the female control group showed a significant decrease in central area time and the ratio of central area time to peripheral area time(P＜0.05).Compared with the female control group,the female daytime restraint group exhibited a significant decrease in central area time and the ratio of central area time to peripheral area time(P＜0.05).There was no significant difference between the groups in the elevated cross maze and Y maze experiments.There was no significant difference in dark latency between the daytime restraint group and the control group,but darkness latency was significantly shorter in the nighttime restraint group compared with those in the control group(P＜0.05).When male and female mice were combined,the immobility time in the daytime restraint group was significantly increased in the tail suspension experiment(P＜0.05),the immobility times of mice in the daytime and nighttime restraint groups were significantly increased in the forced swimming experiment(P＜0.01,P＜0.05),and the central zone time and the ratio of central area time to peripheral area time of daytime restraint mice were significantly shorter compared with those in the control group(P＜0.05,P＜0.01).There was no significant difference in the central zone time and the ratio of central area time to peripheral area time in the nighttime restraint groups,and no significant difference in average speed or total distance between the daytime and nighttime restraint groups.Conclusions Male mice exhibited depression after 28 d of chronic restraint stress during the daytime,while female mice were prone to anxiety after 28 d of chronic restraint stress.Male mice experienced learning and memory impairment after 28 d of chronic restraint stress during the night.

Objective To investigate the effects of chronic restraint stress for 28 days(day and night)on mood and cognitive-like behavior in male and female ICR mice,to provide a basis for the selection of sex and restraint period in chronic restraint stress model animals.Methods A total of 72 male and female(1∶1)ICR mice were divided into six groups:male control,daytime restraint,and nighttime restraint groups,and female control,daytime restraint,and nighttime restraint groups.Mice in all but the control groups were bound for 10 h/d and restrained continuously for 28 days to establish a chronic restraint stress model.The emotional and cognitive behaviors induced by restraint in male and female mice at different times were observed by open field,Y maze,novel inhibition feeding,elevated cross maze,tail suspension,forced swimming,and dark-avoidance experiments.Results In the tail suspension experiment,the immobility time of male mice in the daytime restraint group was significantly increased compared with that in the control group(P＜0.05),and the immobility times of male mice in the daytime and nighttime restraint groups were also significantly increased in the forced swimming experiment,compared with those in the control group(P＜0.05).There was no significant difference between the female daytime restraint and female control groups in the novelty inhibition feeding experiment,but the feeding latency of the nighttime restraint group was significantly longer than that of the control group(P＜0.05)and the daytime restraint group(P＜0.05).The feeding latency of female mice was significantly longer than that of males during nighttime restraint(P＜0.05).In the open field test,compared with the male control group,the female control group showed a significant decrease in central area time and the ratio of central area time to peripheral area time(P＜0.05).Compared with the female control group,the female daytime restraint group exhibited a significant decrease in central area time and the ratio of central area time to peripheral area time(P＜0.05).There was no significant difference between the groups in the elevated cross maze and Y maze experiments.There was no significant difference in dark latency between the daytime restraint group and the control group,but darkness latency was significantly shorter in the nighttime restraint group compared with those in the control group(P＜0.05).When male and female mice were combined,the immobility time in the daytime restraint group was significantly increased in the tail suspension experiment(P＜0.05),the immobility times of mice in the daytime and nighttime restraint groups were significantly increased in the forced swimming experiment(P＜0.01,P＜0.05),and the central zone time and the ratio of central area time to peripheral area time of daytime restraint mice were significantly shorter compared with those in the control group(P＜0.05,P＜0.01).There was no significant difference in the central zone time and the ratio of central area time to peripheral area time in the nighttime restraint groups,and no significant difference in average speed or total distance between the daytime and nighttime restraint groups.Conclusions Male mice exhibited depression after 28 d of chronic restraint stress during the daytime,while female mice were prone to anxiety after 28 d of chronic restraint stress.Male mice experienced learning and memory impairment after 28 d of chronic restraint stress during the night.

Objective:To understand the current status of anemia, iron deficiency, and iron-deficiency anemia among preschool children in China.Methods:A cross-sectional study was conducted with a multi-stage stratified sampling method to select 150 streets or townships from 10 Chinese provinces, autonomous regions, or municipalities (East: Jiangsu, Zhejiang, Shandong, and Hainan; Central: Henan; West: Chongqing, Shaanxi, Guizhou, and Xinjiang; Northeast: Liaoning). From May 2022 to April 2023, a total of 21 470 children, including community-based children aged 0.5 to<3.0 years receiving child health care and kindergarten-based children aged 3.0 to<7.0 years, were surveyed. They were divided into 3 age groups: infants (0.5 to<1.0 year), toddlers (1.0 to<3.0 years), and preschoolers (3.0 to<7.0 years). Basic information such as sex and date of birth of the children was collected, and peripheral blood samples were obtained for routine blood tests and serum ferritin measurement. The prevalence rates of anemia, iron deficiency, and iron-deficiency anemia were analyzed, and the prevalence rate differences were compared among different ages, sex, urban and rural areas, and regions using the chi-square test.Results:A total of 21 460 valid responses were collected, including 10 780 boys (50.2%). The number of infants, toddlers, and preschoolers were 2 645 (12.3%), 6 244 (29.1%), and 12 571 (58.6%), respectively. The hemoglobin level was (126.7±14.8) g/L, and the serum ferritin level was 32.3 (18.5, 50.1) μg/L. The overall rates of anemia, iron deficiency, and iron-deficiency anemia were 10.4% (2 230/21 460), 28.3% (6 070/21 460), and 3.9% (845/21 460), respectively. The prevalence rate of anemia was higher for boys than for girls (10.9% (1 173/10 780) vs. 9.9% (1 057/10 680), χ2=5.58, P=0.018), with statistically significant differences in the rates for infants, toddlers and preschoolers (18.0% (475/2 645), 10.6% (662/6 244), and 8.7% (1 093/12 571), respectively, χ2=201.81, P<0.01), and the rate was significantly higher for children in rural than that in urban area (11.8% (1 516/12 883) vs. 8.3% (714/8 577), χ2=65.54, P<0.01), with statistically significant differences in the rates by region ( χ2=126.60, P<0.01), with the highest rate of 15.8% (343/2 173) for children in Central region, and the lowest rate of 5.3% (108/2 053) in Northeastern region. The prevalence rates of iron deficiency were 33.8% (895/2 645), 32.2% (2 011/6 244), and 25.2% (3 164/12 571) in infants, toddlers, and preschoolers, respectively, and 30.0% (3 229/10 780) in boys vs. 26.6% (2 841/10 680) in girls, 21.7% (1 913/8 821), 40.0% (870/2 173), 27.1% (2 283/8 413), 48.9% (1 004/2 053) in Eastern, Central, Western, and Northeastern regions, respectively, and each between-group showed a significant statistical difference ( χ2=147.71, 29.73, 773.02, all P<0.01). The prevalence rate of iron-deficiency anemia showed a significant statistical difference between urban and rural areas, 2.9% (251/8 577) vs. 4.6% (594/12 883) ( χ2=38.62, P<0.01), while the difference in iron deficiency prevalence was not significant ( χ2=0.51, P=0.476). Conclusions:There has been a notable improvement in iron deficiency and iron-deficiency anemia among preschool children in China, but the situation remains concerning. Particular attention should be paid to the prevention and control of iron deficiency and iron-deficiency anemia, especially among infants and children in the Central, Western, and Northeastern regions of China.

Objective This research assessed the impact of incorporating choledochoscopy with laparoscopic left hepatectomy on stress response and bile duct stone removal in patients presenting with complex intrahepatic biliary stones.Methods Clinical data of 194 patients with complex intrahepatic biliary stones from June 2020 to June 2024 were retrospectively analyzed.The patients were divided into control group (n=97) and observation group (n=97) according to different operation methods.The control group received laparoscopic left hepatectomy,while the observation group received choledochoscopic lithotomy combined with laparoscopic left hepatectomy.The changes of stress indexes[cortisol (Cor),adrenaline (AD)],inflammatory factors[C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)]in the two groups before and 3 days after operation were compared.The liver function indexes[alanine transaminase (ALT),total bilirubin (TBiL),glutamyl transferase (GGT)]of the two groups before and 7 days after operation were compared.The treatment effect levels of the two groups were evaluated 3 months after operation.The incidence of postoperative complications (bile leakage,infection,residual stones and pleural effusion) was recorded and compared between the two groups.Results Three days before and after operation,the levels of Cor,AD,CRP,IL-6 and TNF-α in the two groups had no significant difference (P>0.05),but the postoperative level in two groups were significantly higher than those before surgery,and the differences were statistically significant (P<0.05).Before operation,there was no significant difference in ALT,TBiL and GGT between the two groups (P>0.05).On the 7th day after operation,ALT,TBiL and GGT of the two groups decreased,and the observation group was lower than those of the control group (P<0.05).There was no significant difference in visual analogue scale (VAS),postoperative anal exhaust time and postoperative ambulation time between the two groups (P>0.05).The hospitalization time of the observation group was shorter than that of the control group,the difference was statistically significant (P<0.05).The therapeutic effect of the observation group at 3 months after operation was significantly better than that of the control group,the difference was statistically significant (P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion The combination of laparoscopic left hepatectomy and choledochoscopy effectively addresses complex intrahepatic biliary stones,minimally impacting patient stress responses,enhancing liver function,and reducing complication risks,thereby holding promising clinical applicability.

Objective:To compare the efficacy and safety of adjuvant radiotherapy versus surgery alone in patients with stage pT 2-3N 0M 0 esophageal squamous cell carcinoma after radical resection. Methods:The search was conducted through Web of Science, Emabse, PubMed, Cochrane Library, CNKI, Chongqing VIP, China Biomedical Literature Database, and Wanfang database, etc. The search time was ranged from the establishment of the database to December 2022. Searched studies were screened according to the inclusion and exclusion criteria. Review Manager 5.4 software was used for analysis.Results:Clinical data of 2 424 patients from 8 controlled clinical studies were finally included. Meta-analysis showed that postoperative adjuvant radiotherapy had higher 3-year and 5-year disease-free survival rates ( OR=2.33, 95%CI=1.71-3.17, P<0.001; OR=2.38, 95% CI=1.73-3.27, P<0.001) and 3-year and 5-year overall survival rates ( OR=1.89, 95% CI=1.37-2.60, P<0.01; OR=1.94,95% CI=1.50-2.49, P<0.001) than surgery alone. Meanwhile, the local recurrence rate ( OR=0.33, 95% CI=0.21-0.50, P<0.001) and distant metastasis rate ( OR=0.62, 95% CI=0.39-0.98, P=0.040) of postoperative adjuvant radiotherapy group were lower than those in the surgery alone group. The incidence of radiation esophagitis (1.4%-9.5%), radiation pneumonitis (2.1%) and anastomotic stenosis (5.3%) was reported. Conclusions:For patients with stage pT 2-3N 0M 0 squamous cell carcinoma after radical resection of esophageal cancer, adjuvant radiotherapy may improve 3-year and 5-year disease-free survival rates and 3-year and 5-year overall survival rates compared with surgery alone. In addition, adjuvant radiotherapy may reduce the local recurrence and distant metastasis rates. Therefore, postoperative adjuvant radiotherapy is an optional treatment for stage pT 2-3N 0M 0 esophageal squamous cell carcinoma.

Objective:To discuss the effect of N-myc downstream-regulated gene 1(NDRG1)on the enzalutamide(ENZA)resistance in the castration-resistant prostate cancer(CRPC),and to clarify its mechanism.Methods:The human CRPC C4-2 cells and ENZA-resistant strain C4-2/ENZA cells were cultured in vitro.The expression levels of NDRG1 mRNA in the C4-2/ENZA cells and their parental C4-2 cells were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.The expression levels of NDRG1,androgen receptor(AR),and prostate-specific antigen(PSA)proteins in the cells were detected by Western blotting method to verify the transfection efficiency of the cells.The C4-2/ENZA cells were divided into blank group(normally cultured without treatment),negative control lentivirus(Lv-NC)group(transfected with Lv-NC),Lv-NDRG1 group(transfected with Lv-NDRG1),Lv-NC+ENZA group(transfected with Lv-NC followed by ENZA treatment),Lv-NDRG1+ENZA group(transfected with Lv-NDRG1 followed by ENZA treatment),Lv-NDRG1+epidermal growth factor(EGF)group(transfected with Lv-NDRG1 followed by EGF treatment),and Lv-NDRG1+EGF+ENZA group(transfected with Lv-NDRG1 followed by EGF and ENZA treatment).The half-maximal inhibitory concentration(IC50),resistance index(RI),and proliferation activity of the cells were detected by MTT assay;the apoptotic rates of the cells in various groups were detected by flow cytometry;RT-qPCR method was used to detect the expression levels of NDRG1 mRNA in the cells in various groups;Western blotting method was used to detect the expression levels of NDRG1,AR,phosphorylated AR at serine213(p-ARSer213),phosphorylated AR at serine81(p-ARSer81),and PSA proteins in the cells in various groups.Results:Compared with C4-2 cells,the expression levels of NDRG1 mRNA and protein in the C4-2/ENZA cells were significantly decreased(P<0.01)and the expression levels of AR and PSA proteins were increased(P<0.01),indicating low expression of NDRG1 in the ENZA-resistant C4-2/ENZA strain.Compared with Lv-NC group,the expression levels of NDRG1 mRNA and protein in the cells in Lv-NDRG1 group were significantly increased(P<0.01),indicating the successful construction of an NDRG1 gene over-expression strain of C4-2/ENZA resistant cells.The MTT assay results showed that compared with the C4-2 cells,the IC50 of the C4-2/ENZA cells was increased(P<0.01)and the RI was 17.78;compared with Lv-NC group,the IC50 of the C4-2/ENZA cells in Lv-NDRG1 group was decreased(P<0.01).After 24 h of EGF treatment,compared with Lv-NC group,the IC50 of the C4-2/ENZA cells in Lv-NC+EGF group was significantly increased(P<0.01);compared with Lv-NDRG1 group,the IC50 of the C4-2/ENZA cells in Lv-NDRG1+EGF group was increased(P<0.01).Compared with before ENZA treatment,after 24 h of ENZA treatment,the proliferation activities of C4-2 and C4-2/ENZA cells were gradually decreased(F=223.80,P<0.01;F=81.46,P<0.01).Compared with Lv-NC group,the proliferation activity in the C4-2/ENZA cells in Lv-NDRG1 group after 24 h of ENZA treatment was significantly decreased(P<0.01).After 24 h of EGF treatment,compared with Lv-NC group,the proliferation activity of the C4-2/ENZA cells in Lv-NC+EGF group was significantly increased(P<0.01),while the the proliferation activity of the C4-2/ENZA cells in Lv-NDRG1+EGF group was significantly decreased(P<0.01).The chosen concentration and treatment duration for further testing were 10 000 μmol·L-1 ENZA and the intervention time was 24 h.The flow cytometry results showed that after 24 h of ENZA treatment,compared with Lv-NC group,the apoptotic rate of the cells in Lv-NDRG1 group was significantly increased(P<0.01);compared with Lv-NC+ENZA group,the apoptotic rate of the cells in Lv-NDRG1+ENZA group was significantly increased(P<0.01).After 24 h of EGF treatment,compared with Lv-NDRG1 group,the apoptotic rate of the cells in Lv-NDRG1+EGF group was significantly decreased(P<0.01),while the apoptotic rate of the cells in Lv-NDRG1+ENZA group was significantly increased(P<0.01);compared with Lv-NDRG1+ENZA group,the apoptotic rate of the cells in Lv-NDRG1+EGF+ENZA group was significantly decreased(P<0.01).The Western blotting results showed that after 24 h of ENZA treatment,compared with Lv-NC group,the expression levels of AR and PSA proteins and the ratio of p-ARSer213/AR and p-ARSer81/AR in the cells in Lv-NDRG1 group were significantly decreased(P<0.05 or P<0.01).After 24 h of EGF treatment,compared with Lv-NC group,the expression levels of AR and PSA proteins and the ratio of p-ARSer213/AR and p-ARSer81/AR in the cells in Lv-NC+EGF group were significantly increased(P<0.05 or P<0.01);compared with Lv-NDRG1 group,the expression levels of AR and PSA proteins and the ratio of p-ARSer213/AR and p-ARSer81/AR in the cells in Lv-NDRG1+EGF group were significantly increased(P<0.01).Conclusion:Over-expression of NDRG1 can reduce the resistance of CRPC to ENZA,and its mechanism may be related to the inhibition of AR signaling.

Objective To compare image quality and radiation dose for abdominal CT angiography(CTA)in infants and young children after liver transplantation using energy spectrum CT and low tube voltage scanning.Methods Totally 41 infants or young children after liver transplantation were included,including 22 cases who underwent energy spectrum CT(energy spectrum group)and 19 cases who underwent low tube voltage(80 kV)CT scanning(low tube voltage group).50 keV single energy images of energy spectrum group were extracted to observe abdominal blood vessels.Subjective and objective evaluation on image quality were performed,the latter aimed at CT value and noise value of hepatic artery and portal vein,the contrast and contrast-to-noise ratio(CNR)of hepatic artery and portal vein.The examined volume CT dose index(CTDIvol),dose-length product(DLP)and effective dose(ED)of both groups were recorded.Results No significant difference of subjective image quality score was found between groups(P＞0.05).In low tube voltage group,during arterial phase,CT values of hepatic artery,contrastarteries and CNRarteries were higher,and during the portal vein phase,CT values of hepatic artery,liver tissue noise,contrastportalvein and CNRportalvein were all higher than those in energy spectrum group(all P＜0.05).CTDIvol,DLP and ED in energy spectrum group were higher than those in low tube voltage group(all P＜0.05).Conclusion Compared with energy spectrum CT,low tube voltage CT scanning combined with iterative reconstruction technology could result better image quality and lower radiation dose for abdominal CTA in infants and young children after liver transplantation.

Objective:To evaluate the function of serum dehydroepiandrosterone sulfate (DHEAS) in adult adrenal space-occupying lesions.Methods:In this cross-sectional study, 395 patients with adrenal space-occupying lesions who had their DHEAS levels measured were collected from the First Medical Center of Chinese PLA General Hospital from January 2010 to June 2021. They were divided into the adrenal Cushing syndrome (ACS) group ( n=100) and non-ACS group ( n=295). The former was divided into the cortisol-producing adrenal adenoma (CPA) group ( n=67) and primary bilateral macronodular adrenal hyperplasia (PBMAH) group ( n=33). Clinical data of each group were collected and compared among groups by independent samples t-test, chi-square test, and Mann-Whitney U test. Serum DHEAS ratio corrected for age and sex was further constructed to identify the receiver operating characteristic curve and the optimal tangent point value for different adrenal occupation. Results:Patients in the ACS group were younger (44.9±13.7 vs. 49.9±12.5, P=0.001); had a larger proportion of women (79/100 vs.139/295, P=0.001); and had higher cortisol levels [8∶00Am, 497.31 (343.52, 606.50) vs. 353.11 (267.50, 487.91) nmol/L, P<0.001] than those in the non-ACS group. The serum DHEAS level and ratio in the ACS group were significantly lower than those in the non-ACS group [0.50 (0.40, 1.21) vs. 2.68 (1.56, 4.32) μmol/L, 1.00 (0.43, 1.68) vs. 3.17 (2.21, 4.54), both P<0.001]. When the serum DHEAS ratio cut-off point was 1.29, the sensitivity and specificity for differential diagnosis of ACS and non-ACS were 72.0% and 91.5% respectively. The ratio of DHEAS in the CPA group was lower [0.58 (0.27, 1.05) vs. 1.14 (1.04, 2.40), P<0.001] than that in the PBMAH group. When the serum DHEAS ratio cut-off point was 0.99, the sensitivity and specificity for differential diagnosis of CPA and PBMAH were 64.2% and 81.2% respectively. Conclusion:Corrected age-sex DHEAS ratio can assist in the functional assessment of adrenal space-occupying lesions.