OBJECTIVE To estimate the cost-effectiveness of penpulimab combined with chemotherapy versus chemotherapy alone in first-line treatment of advanced squamous non-small-cell lung cancer （sq-NSCLC）. METHODS From the perspective of Chinese health system， cost-utility analysis was used to evaluate the cost-effectiveness of penpulimab combined with chemotherapy （paclitaxel + carboplatin） versus chemotherapy （paclitaxel + carboplatin） in first-line treatment of sq-NSCLC. A three-health states Markov model was constructed with R packages， and clinical data used in the model were derived from the AK105-302 clinical trial. Costs and utilities were collected from the open-access database and published literature. The quality-adjusted life-years （QALY） was used as the utility index， and the willingness-to-pay （WTP） threshold was set at three times China’s per capita GDP in 2024， equivalent to 287 247 yuan/QALY. The cost-effectiveness of the schemes was evaluated by comparing the incremental cost- utility ratios （ICER） of the two schemes with the WTP threshold. One-way sensitivity analysis and probabilistic sensitivity analysis （PSA） were used to verify the stability of the basic analysis results. RESULTS Compared with chemotherapy， penpulimab combined with chemotherapy increased 0.73 QALY with an incremental cost of 150 681.93 yuan， and the ICER was 206 413.60 yuan/QALY. One-way sensitivity analysis showed that the utility of progression-free survival was the most sensitive factor on ICERs. At the WTP threshold of 3 times China’s per capita GDP， the economic probability of this scheme was 98.80%. At the WTP threshold of 1 times China’s per capita GDP， the probability of ICER being cost-effective was less than 0.01%. CONCLUSIONS For patients with advanced sq-NSCLC， penpulimab combined with chemotherapy is a cost-effective first-line treatment option when WTP threshold is 3 times China’s per capita GDP.

BackgroundFluvoxamine is increasingly used in the treatment for depressive disorder in adolescents. However， little research has been done on the effect of fluvoxamine on lipid metabolism， and the disordered lipid metabolism would cause severe harm to the health of patients and affect relevant prognosis. ObjectiveTo analyze the effect of fluvoxamine on lipid metabolism in adolescent patients with depressive disorder and to investigate the safety of fluvoxamine treatment. MethodsFrom June 2022 to June 2023， 60 adolescent patients with depressive disorder were involved， who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） and received inpatient treatments in Shanxi Mental Health Center. These cases were randomly divided into study group （receiving fluvoxamine treatment） and control group （receiving sertraline treatment） with 30 cases in each group. The treatment period was 4 weeks. At baseline as well as 2 weeks and 4 weeks after treatment， both groups' indexes of fasting lipid metabolism were measured， including serum total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein （HDL） and low-density lipoprotein （LDL）， and Hamilton Depression Scale-17 item （HAMD-17） was adopted. The levels of lipid metabolism indexes and HAMD-17 score were compared between the two groups at different follow-up time points. ResultsFor HAMD-17 score， the time effect was statistically significant （F=849.687， P<0.01）， while the inter-group effect and interaction effect was not statistically significant （F=0.033， 1.760， P>0.05）. For TC levels， the inter-group effect was not statistically significant （F=1.461， P=0.232）， but the time effect and interaction effect were statistically significant （F=13.129， 5.029， P<0.05 or 0.01）. The time effect and the inter-group effect of TG level were not statistically significant （F=0.825， 0.185， P>0.05）， but the interaction effect was statistically significant （F=7.577， P=0.004）. For HDL levels， the time effect， inter-group effect and interaction effect were not statistically significant （F=1.079， 0.160， 1.877， P>0.05）. For LDL levels， there was no statistical significance in the inter-group effect （F=0.019， P=0.891）， while statistical significance was observed in both time effect and interaction effect （F=6.721， 9.075， P<0.01）. ConclusionFluvoxamine and sertraline have curative effectiveness of same level on adolescent depression disorder， and short-term application of fluvoxamine has little effect on lipid metabolism indexes of patients. ［www.chictr.org.cn number： ChiCTR2300074129］

Objective To explore the value of dynamic ultrasound combined with 3.0T MRI for diagnosing and typing synovial plica of knee joint.Methods Dynamic ultrasound and 3.0T MRI data of 100 patients with suspected synovial plica of knee joint were retrospectively analyzed.Taking the results of arthroscopy as standards,the efficacy of dynamic ultrasound and 3.0T MRI alone and their combination for diagnosing synovial plica of knee joint were evaluated and compared.The length and thickness of synovial plica of knee joint measured with dynamic ultrasound,3.0T MRI alone and their combination were compared with those of arthroscopy,and the consistencies of the location and classification of synovial plica of knee joint with arthroscopy were analyzed.Results Synovial plica was detected in 70 cases,including 11 cases of supropatellar synovial plica,15 cases of infrapatellar synovial plica,medial patellar in 30 cases and lateral patellar synovial plica in 14 cases,among them type A,B,C and D were classified in 9,35,23 and 3 cases,respectively.No significant difference of sensitivity was found between dynamic ultrasound and 3.0T MRI alone for diagnosing synovial plica of knee joint(P＞0.05),which were both lower than that of their combination(both P＜0.05).The length and thickness of knee synovial plica measured with dynamic ultrasound and 3.0T MRI alone were lower than those measured with their combination and arthroscopy(all P＜0.05),and there was no significant difference between the results of their combination and arthroscopy(both P＞0.05).Dynamic ultrasound,3.0T MRI alone and their combination had high consistency of location(Kappa=0.755,0.826,0.897)and classification of knee synovial plica with those of arthroscopy(Kappa=0.721,0.744,0.860).Conclusion Dynamic ultrasound combined with 3.0T MRI was valuable for diagnosing and typing of synovial plica of knee joint.

Objective:To evaluate the efficacy and safety of unilateral adrenalectomy for treating primary bilateral macronodular adrenal hyperplasia (PBMAH) of different clinical types.Methods:The clinical and biochemical data of 54 patients with PBMAH who underwent unilateral adrenalectomy from May 2008 to March 2023 were retrospectively collected. Preoperative CT images of all patients showed enlarged bilateral adrenal glands with multiple nodules of " fused masses". Mean preoperative blood cortisol concentration at 8am was (21.5±7.7)μg/dl, urinary free cortisol concentration was (442.6±300.4)μg/24h, and mean 8am ACTH concentration was (6.4±2.3)pg/ml. Postoperative symptoms, BMI, blood pressure, mass diameter, cortisol and ACTH concentration were recorded and analyzed.Results:Compared with ordinary laparoscopic surgery, robot-assisted surgery showed shorter operation time [(115.4±22.1)min vs.(95.0±19.8)min, P=0.045]; less blood loss [(118.2±57.0)ml vs. (125.6±45.3)ml, P=0.441] and shorter hospitalization time [(5.2±0.9)day vs. (6.4±1.2)day, P=0.279]. Compared with laparoscopic surgery, open surgery showed longer operation time [(134 34.5) min vs. (104.3±20.1) min, P=0.035]; more blood loss [(305.5±85.2) ml vs. (122.5±44.3) ml, P=0.012] and longer hospitalization time[(10.4±3.2)day vs. (5.7±1.0) day, P=0.020]. The average follow-up time was (23.7±11.7) months. Sixteen cases biochemically relapsed, and the average relapse-free time was (25.4±13.4) month. Mean postoperative systolic blood pressure was (131.1±16.8)mmHg ( P=0.001) while diastolic blood pressure decreased to (82.2±11.1)mmHg ( P=0.002). Postsurgical average blood cortisol concentration decreased to (10.2±4.0)μg/dl ( P<0.01), while urine cortisol concentration decreased to (106.6±43.4)μg/24h( P<0.01). Average ACTH concentration increased to (12.6±4.1)pg/ml( P=0.005). Recurrent patients had higher preoperative blood and urine cortisol concentration(24.7±8.2)μg/dl( P=0.046), (522.8±234.2)μg/24h( P=0.028), and all of them underwent contralateral adrenalectomy. Conclusions:Unilateral adrenalectomy is safe and effective for treatment of PBMAH while part of patients biochemically relapsed. Subclinical patients were observed no recurrent cases after surgery. Recurrent patients have higher preoperative blood and urine cortisol levels and should undertake contralateral adrenalectomy and supplement corticosteroids for whole life.

Objective To investigate the effects of B cell lymphoma factor-3(Bcl-3)on estrogen receptor α(ERα)signaling pathway and cell proliferation in breast cancer.Methods MCF-7 cells at the logarithmic growth stage were randomly divided into the siControl group and the siBcl-3#1 group.The cells were added with ControlsiRNA and siBcl-3#1siRNA,respectively,and transfected with LipofectamineTM 2000 for 5 hours.MCF-7 cells in the siControl group and siBcl-3#1 group were obtained after stable transfection for 48 hours.The expressions of Bcl-3,growth regulation by estrogen in breast cancer 1(GREB1),PDZ domain protein 1(PDZK1),and Erα target gene trefoil factor 1(TFF1)mRNA in MCF-7 cells were detected by quantitative real-time polymerase chain reaction.The expressions of Bcl-3 and ERα protein in MCF-7 cells were detected by Western blot assay,and the proliferation of MCF-7 cells was detected by cell counting kit-8.HEK293T cells were randomly divided into the Input group(positive control group),IP group(co-immunoprecipitation group),and IgG group(negative control group).After co-transfected with Bcl-3 and ERα plasmids for 48 hours,the cells were lysed with 100 μL co-immunoprecipitation(Co-IP)cell lysate on ice,and the supernatant was separated.In the Input group,90 μL supernatant was taken and added with 30 μL 4 × Loading buffer.In the IP group,450μL supernatant was taken and added with 40 μL protein A/G and 0.5 μL green fluorescent protein antibody.In the IgG group,450 μL supernatant was taken and added with 0.5 μL IgG and 30 μL protein A/G magnetic agarose beads.The binding effect of Bcl-3 and ERα was detected by Co-IP assay.MCF-7 cells at the logarithmic growth stage were selected,and the co-localization of Bcl-3 and ERα was detected by an immunofluorescence co-localization experiment.Results The relative expression levels of Bcl-3,GREB1,TFF1 and PDZK1 mRNA in MCF-7 cells in the si-Bcl-3#1 group were significantly lower than those in the siControl group(P＜0.05).The relative expression levels of Bcl-3 and ERα protein in MCF-7 cells in the si-Bcl-3#1 group were significantly lower than those in the siControl group(P＜0.05).There was no significant difference in the proliferation ability of MCF-7 cells between the si-Bcl-3#1 group and the siControl group at 0 h and 24 h after culture(P＞0.05).The proliferation ability of MCF-7 cells in the si-Bcl-3#1 group was significantly lower than that in the siControl group at 48 h and 72 h after culture(P＜0.05).The results of the Co-IP assay showed that there was interaction between Bcl-3 and ERα.The results of the immunofluorescence co-localization experiment showed that the co-localization of Bcl-3 and ERα existed.Conclusion Bcl-3 is highly expressed in breast cancer cells,which can enhance the conduction activity of the ERα signaling pathway and promote the proliferation of ERα positive breast cancer cells.

Objective:To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF).Methods:220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ2 test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results:There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P ?

Sex-determining region Y-related high-mobility group box 11(SOX11)was initially considered as one of the trans-acting factors supporting the differentiation of stem cells and the survival of neural precursors.However,in recent studies,it was found that SOX11 played an important role in the transcriptional regulation of the development,shaping and regeneration of neurons,and it was expected to be a target for the regeneration of injured nerves.This article reviews the physiological and pathophysiological functions of SOX11 in the central nervous system and its role in nerve regeneration.

The erector spinae plane block(ESPB)technique proposed by Forero et al.has drawn increasing attention due to its reliable effects and fewer complications in simple and safe procedures.It has been successfully applied in anesthesia management during the perioperative period.This article mainly introduces the anatomical basis,possible mechanism of action,common operating methods,and clinical applications during the perioperative period of ESPB.Starting from the advantages,disadvantages,and complications of ESPB,it compares ESPB with other common thoracolumbar analgesic methods,providing better evidence support for the perioperative application and future development of ESPB.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Purpose: To determine the non-contrast computer tomography imaging features of pyonephrosis and evaluate the predictive value of Hounsfield units (HUs) in different hydronephrotic region slices. Materials and Methods: We retrospectively reviewed data from patients with hydronephrosis who had renal-ureteral calculi. All patients were categorized into pyonephrosis and simple hydronephrosis groups. Baseline characteristics, the mean HU values in the maximal hydronephrotic region (uHU) slice, and the range of uHU in different slices (△uHU) were compared between the two groups. Univariate and multivariate analyses were performed to identify risk factors for pyonephrosis. Results: Among the 181 patients enrolled in the current study, 71 patients (39.2%) were diagnosed with pyonephrosis. The mean dilated pelvis surface areas were comparable between patients with pyonephrosis and simple hydronephrosis (822.61 ㎟ vs.877.23 ㎟ , p=0.722). Collecting system debris (p=0.022), a higher uHU (p=0.038), and a higher △uHU (p<0.001) were identified as independent risk factors for pyonephrosis based on multivariate analysis. The △uHU sensitivity and specificity were 88.7% and 86.4%, respectively, at a cutoff value of 6.56 (p<0.001), whereas the sensitivity and specificity for detecting pyonephrosis at a uHU cutoff value of 7.96 was 50.7% and 70.9%, respectively (p=0.003). Conclusions Non-contrast computer tomography was shown to accurately distinguish simple hydronephrosis from pyonephrosis in patients with obstructive uropathy. Evaluation of the △uHU in different slices may be more reliable than the uHU acquired from a single slice in predicting pyonephrosis.