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.

Background::Bladder cancer, characterized by a high potential of tumor recurrence, has high lifelong monitoring and treatment costs. To date, tumor cells with intrinsic softness have been identified to function as cancer stem cells in several cancer types. Nonetheless, the existence of soft tumor cells in bladder tumors remains elusive. Thus, our study aimed to develop a microbarrier microfluidic chip to efficiently isolate deformable tumor cells from distinct types of bladder cancer cells.Methods::The stiffness of bladder cancer cells was determined by atomic force microscopy (AFM). The modified microfluidic chip was utilized to separate soft cells, and the 3D Matrigel culture system was to maintain the softness of tumor cells. Expression patterns of integrin β8 (ITGB8), protein kinase B (AKT), and mammalian target of rapamycin (mTOR) were determined by Western blotting. Double immunostaining was conducted to examine the interaction between F-actin and tripartite motif containing 59 (TRIM59). The stem-cell-like characteristics of soft cells were explored by colony formation assay and in vivo studies upon xenografted tumor models. Results::Using our newly designed microfluidic approach, we identified a small fraction of soft tumor cells in bladder cancer cells. More importantly, the existence of soft tumor cells was confirmed in clinical human bladder cancer specimens, in which the number of soft tumor cells was associated with tumor relapse. Furthermore, we demonstrated that the biomechanical stimuli arising from 3D Matrigel activated the F-actin/ITGB8/TRIM59/AKT/mTOR/glycolysis pathways to enhance the softness and tumorigenic capacity of tumor cells. Simultaneously, we detected a remarkable up-regulation in ITGB8, TRIM59, and phospho-AKT in clinical bladder recurrent tumors compared with their non-recurrent counterparts.Conclusions::The ITGB8/TRIM59/AKT/mTOR/glycolysis axis plays a crucial role in modulating tumor softness and stemness. Meanwhile, the soft tumor cells become more sensitive to chemotherapy after stiffening, that offers new insights for hampering tumor progression and recurrence.

Objective:To explore the clinical effect of SVF-gel transplantation combined with double eyelid operation for upper eyelid depression.Methods:From January 2018 to October 2019, the Cosmetic Surgery Department of Henan Plastic Surgery Hospital treated 58 famale patients with sunken single eyelid and double eyelid, they aged 24-53, and the average age was (35±7) years old. A total of 58 patients with sunken upper eyelid were divided into two groups: SVF-gel group (study group) and traditional autologous fat (Coleman fat) group (control group), 29 cases in each group. Before the operation, patients in the study group were injected with SVF-gel, while those in the control group were injected with Coleman fat. After filling the fat, the traditional double eyelid line was designed in both groups.Results:Three months after operation, the patients in the study group and the patients in the control group had same survival rate of fat filling: the satisfactory rate of fat filling and the effect of double eyelid were 93.10% and 89.66% in the study group, respectively, while 82.76% and 82.76% in the control group.In the control group, there were 4, 1 and 3 cases of gross appearance, tubercle and unevenness respectively, while in the study group, there were no postoperative complications.Conclusions:SVF-gel is superior to traditional structural fat in the double eyelid surgery of upper eyelid sunken type. The patients are satisfied with the surgery and the clinical effect is good.

Objective:To investigate the effects of SuperPATH approach versus conventional posterolateral approach in total hip replacement on inflammatory response, hip function, and quality of life in patients with hip diseases. Methods:The clinical data of 140 patients with hip diseases who underwent total hip replacement in Shanxian Central Hospital from March 2017 to May 2019 were retrospectively analyzed. These patients were divided into SuperPATH approach ( n = 70) and posterolateral approach ( n = 70) groups. Operation-related indexes, inflammatory response indexes, hip function, quality of life, and pain were compared between the two groups. Results:Intraoperative blood loss was significantly less in the SuperPATH approach group than in the posterolateral approach group [(105.40 ± 15.11) mL vs. (196.89 ± 24.26) mL, t = 26.74, P < 0.001]. Incision length, postoperative time to getting out of bed, length of hospital stay in the SuperPATH approach group were (6.85 ± 1.42) cm, (2.92 ± 0.28) days, and (6.67 ± 1.36) days, respectively, which were significantly shorter than those in the posterolateral approach group [(13.07 ± 1.89) cm, (8.36 ± 1.45) days, (10.91 ± 1.34) days, t = 19.36, 30.82, 18.58, P < 0.001]. Operative time was significantly longer in the SuperPATH approach group than in the posterolateral approach group [(69.38 ± 8.62) minutes vs. (60.45 ± 7.79) minutes, t = 6.43, P < 0.001). The scores of social role functioning, general health perceptions, vitality, mental health, bodily pain, emotional role functioning, physical functioning, and physical functioning measured 6 months after surgery were significantly higher in the SuperPATH approach group than in the posterolateral approach group ( t = 9.12, 11.80, 11.64, 11.69, 6.45, 11.79, 6.04, 10.74, all P < 0.001). There were no significant differences in C-reactive protein and erythrocyte sedimentation rate measured 3 and 14 days after surgery between the two groups (both P > 0.05). Harris score used for evaluation of hip function 1 month after surgery was significantly higher in the SuperPATH approach group than in the posterolateral approach group [(76.42 ± 4.17) points vs. (69.37 ± 5.11) points, t = 8.94, P < 0.001]. The Visual Analog Scale score 3 days after surgery was significantly lower in the SuperPATH approach group than in the posterolateral approach group [(3.18 ± 0.21) points vs. (4.26 ± 0.29) points, t = 25.23, P < 0.001]. Conclusion:Compared with the conventional posterolateral approach, the SuperPATH approach for total hip arthroplasty takes longer operative time, but it can better reduce early postoperative pain, promote hip function recovery, and improve quality of life.

Objective To assess the relationship between the serum IgG antibody titer of pregnant women and the hemolytic dis‐ease of newborn(HDN) .Methods Using microcolumn gel coombs card assay method to determine titer of 255 cases of couples an‐tenatal serum IgG antibody and ABO blood group .Results with 195 cases of ABO‐incompatible couples ,the positive rate of abnor‐mal serum IgG antibody(≥64)was 93 .8% .The titer of anti‐A/B IgG :in 12(6 .2% ) cases was <64;in 12(6 .2% )cases was 64;in 60(30 .8% )cases was 128 ;in 39(20% )cases was 256 ;in 45(23 .0% )cases was 512 ;in 27(13 .8% ) cases was 1 024 .There were no statistical differences between IgG anti‐A(B) titers distribution between A/O blood group matching and B/O blood group matching (χ2 =4 .361 ,P=0 .499) ,IgG anti‐A( B) titers was higher in AB/O blood group matching .Conclusion we can take early and effec‐tive prevention ,treatment ,reducing the incidence of HDN by the determination of prenatal serum IgG antibody titers in ABO‐in‐compatible couples ,which is important for the population of eugenics .

Objective To assess dermatoscopic characteristics of lichen sclerosus(LS). Methods Dermatoscopy was performed to observe 27 genital or extragenital porcelain-white skin lesions in 15 outpatients with confirmed LS. Results As dermatoscopy showed, of the 27 skin lesions, 24 showed white-yellowish structureless areas, 25 linear vessels, 27 white patches, 17 keratotic plugs. Characteristic cloverleaf-like structure was observed in 7 skin lesions in 4 patients, which was consistent with LS. Conclusion Patients with LS show atypical clinical manifestations, but specific dermatoscopic patterns.

Objective To analyze causative factors for and therapeutic effect of total glucosides of paeony (TGP) on palmoplantar pustulosis (PPP).Methods Ninety patients with PPP were recruited in this study.A questionnaire survey was carried out to collect clinical data from these patients,and a patch test to identify contact allergens for these patients.All the patients were randomly divided into two groups:observation group treated with TGP capsule 0.6 g thrice a day,and control group treated with tripterygium glycosides tablets 20 mg thrice a day.Both groups topically applied mometasone furoate cream once a day.The efficacy and side effects were evaluated 4 and 8 weeks after initiation of treatment.Results Of the 90 patients,the ratio of male to female was 1 ∶ 1.64,smokers amounted to 42.22％,and 23 (26.67％) reported a history of infection before the onset of PPP.As the patch test showed,potassium dichromate and nickel sulfate were the most common contact allergens in these patients.The response rate was significantly higher in the observation group than in the control group after 4 weeks of treatment (64.44％ vs.40.00％,x2 =5.388,P ＜ 0.05),but similar between the two groups after 8 weeks of treatment (88.89％ vs.80.00％,x2 =1.353,P ＞ 0.05).No significant difference was observed in the occurrence of adverse reactions between the two groups (17.78％ vs.11.11％,x2 =0.809,P ＞ 0.05).Conclusions Smoking may play a certain role in the development of PPP,and infection seems to be a primary inducing factor.TGP combined with mometasone furoate cream is effective for the treatment of PPP.

BACKGROUND:Improper angle of prosthesis placement often induces acetabular cup impact, and limits the scope of activity of artificial hip joint, and cannot meet the requirement of daily life. At present, the angle of acetabular cup instal ation remains controversial during total hip arthroplasty. Moreover, there is lack of targeted guide for the acetabular cup instal ation during hip arthroplasty with different head-neck ratios. OBJECTIVE:To explore the safe range of the artificial acetabular cup instal ation angle for different head-neck ratios. METHODS:In accordance with the calculation formula of range of internal rotation and external rotation, abduction and adduction, flexion and extension after total hip replacement, interpretation of dynamical variety law of acetabular abduction and anteversion, and deriving inequalities depending on Widmer’s standard of artificial hip joint normal activities range:(1) external rotation range was at least 40°, and internal rotation range was at least 80°. (2) Abduction range was at least 50°, and adduction range was at least 50°. (3) Anteflexion range was at least 130°, and extension range was at least 40°. The safety scope of artificial hip joint instal ation angle at different head-neck ratios was determined by solving the above three groups of inequality. RESULTS AND CONCLUSION:The safe range of the artificial acetabular cup instal ation angle for different head-neck ratios was different. To meet the normal hip joint activities, the head-neck ratios of artificial hip should be greater than 22/12. Artificial hip joint activities gradual y increase with the enlargement of head neck ratios. With enlarging the head-neck ratios, the acetabular cup instal ation safety angle scope of abduction and anteversin gradual y increases and the extreme of abduction increases gradual y, then with anteversion increasing gradual y, the abduction upper extreme of the security scope gradual y decrease and lower extreme of the security scope gradual y increase, tending to 45° symmetrical y. When anteversion is the biggest, the abduction should be 45°.

Objective To investigate the distribution of nail disorders in patients with a chief complaint of nail abnormalities. Methods From May 2007 to May 2010, patients who attended the dermatology outpatient clinic with a chief complaint of nail abnormalities were included in this study. Routine dermatological examination together with fungal culture, microscopic and pathological examination of affected nails was carried out to clarify the diagnosis of nail disorders. The results were statistically analyzed. Results Of the 2776 cases,onychomycosis accounted for 45.28% (1257), followed by paronychia (479, 17.26%) and psoriasis (122,4.39%). Conclusion In this region, patients with a chief complaint of nail disorders are most likely to suffer from nail infections.

BACKGROUNDTo summarize the clinical results of bronchoplastic procedures and pulmonary artery reconstruction or combined with other resection and plasty of heart, great vessels in the treatment of 304 patients with locally advanced lung cancer.

METHODSFrom February, 1983 to December, 2001, double sleeve resection and reconstruction of bronchus and pulmonary artery, or combined with other resection of heart, great vessels were carried out in 304 patients with locally advanced lung cancer. The operations included double sleeve left upper lobectomy in 199 cases; double sleeve right upper lobectomy in 21 cases; double sleeve right upper middle lobectomy in 14 cases; double sleeve left upper lobectomy combined with resection of left atrium in 8 cases; double sleeve right upper lobectomy combined with superior vena cava (SVC) resection and reconstruction with Gortex graft in 29 cases; double sleeve right upper middle lobectomy combined with SVC resection and reconstruction in 21 cases; double sleeve right upper middle lobectomy, carinal and SVC resection and reconstruction in 11 cases; left pneumonectomy combined right main pulmonary artery and pulmonary artery trunk resection and reconstruction with Gortex graft in 1 case.

RESULTSThere were 3 operative deaths. The operative mortality was 1% in this series. Sixty four patients had operative complications. The operative complication rate was 21.05% (64/304). The 1-, 3-, 5- and 10 year survival rates were 81.75%, 60.14%, 37.21% and 24.39% respectively.

CONCLUSIONSDouble sleeve lobectomy or comblined with other resection and reconstruction of heart, great vessels can significantly improve the prognosis and increase the curative rate and long term survival in patients with locally advanced lung cancer.