ObjectiveTo explore the effect of Shenge Bushen Capsules （SBC） on sexual development in normal 3-week-old mice. MethodsThe experiment consisted of two parts. In the first part， mice were divided into four groups： The control group and the low， medium， and high-dose SBC groups （234.7， 469.4， 938.7 mg·kg^-1， respectively）. In the second part， mice were divided into four groups： Control group， Pseudostellariae Radix polysaccharide （PRP） group， total flavonoids group， and SBC group， all receiving a dose of 469.4 mg·kg^-1. After 7 days of administration， the vaginal opening of female mice and the descent of testes and scrotum in male mice， as well as the ovarian and testicular organ indices， were observed. After 4 weeks of administration， female and male mice were housed together for 2 days， and the pregnancy rate of females was monitored. After delivery， the pregnant female mice continued receiving the treatment for 4 weeks， and the sexual development of their offspring， including vaginal opening， testicular descent， and organ indices of ovaries and testes， was observed. Serum sex hormones were measured by enzyme-linked immunosorbent assay （ELISA）， and the expression of gonadotropin-releasing hormone （GnRH） and growth hormone （GH） proteins in the hypothalamus was assessed by Western blot. ResultsCompared with the control group， there was no significant effect on the vaginal opening of female mice or the descent of testes in male mice after 7 days of SBC administration. After 4 weeks of administration， the pregnancy rate in the low-dose group was significantly reduced （P<0.05）， but no significant effects were observed in the other groups. The three doses of SBC did not significantly affect the ovarian or testicular organ indices， and there was no significant upregulation in the expression of GnRH or GH in the hypothalamus. The primary component of SBC， Pseudostellariae Radix polysaccharide， significantly reduced the vaginal opening in female mice after 7 days of administration （P<0.05）. After 4 weeks， the serum estradiol levels of non-pregnant female mice were decreased （P<0.05）， but there was no significant effect on the expression of GnRH or GH proteins in the hypothalamus of either male or female mice. Additionally， there were no significant effects on precocious puberty indicators， such as vaginal opening and testicular descent， in the offspring mice. ConclusionSBC does not significantly promote precocious puberty in young mice， and it does not have any noticeable effects on the pregnancy rate of adult mice or the sexual development of their offspring.

OBJECTIVE To review the current research progress on pharmacoeconomics evaluation related to spinal muscular atrophy （SMA）， in order to provide valuable insights for clinical treatment， screening and medical insurance payment decision- making. METHODS A computerized search was conducted across multiple databases including PubMed， Web of Science， Embase， Scopus， Cochrane Library， EBSCOhost， CNKI， VIP， CBM and Wanfang database as well as other important health technology assessment （HTA） websites， such as National Institute for Health and Care Research，International Society of Technology Assessment in Health Care， Agency for Healthcare Research and Quality， etc. The pharmacoeconomics evaluation studies related to SMA were collected from the inception to December 31st， 2023. The literature/reports were rigorously screened based on predefined inclusion and exclusion criteria by two researchers， and the essential information from the included literature/ reports was extracted using Excel 2019. The quality of the included literature/reports was evaluated by Consolidated Health Economic Evaluation Reporting Standards 2022. RESULTS Finally， 9 articles and 15 HTA reports were included， with overall good quality of literature， but poor quality of HTA reports. There were a total of 24 studies on the pharmacoeconomics evaluation of SMA， including treatment options such as nusinersen sodium， sovaprevir， risperidone， and best supportive therapy.The review results showed that nusinersen sodium was not cost-effective in the treatment of SMA； there was no consensus on the economic viability of treatment options such as risperidone and sovaprevir； newborn/prenatal screening combined withmedication therapy was cost-effective. CONCLUSIONS newborn/prenatal screening combined with SMA medication therapy demonstrates economic advantages. It is suggested to further investigate the cost-effectiveness of new SMA drugs and SMA screening in China， taking localization parameters and medical insurance prices into account， and gradually incorporate SMA screening into the scope of neonatal genetic disease detection， in order to alleviate the financial burden of patients’ families and healthcare systems.

Objective To compare the therapeutic effects of flexible ureteroscope(FURS),super-mini percutaneous nephrolithotomy(SMP),and microstomy percutaneous nephrolithotomy(MPCNL)in the treatment of 2-3 cm lower calyceal calculi.Methods Clinical data of 209 patients with 2-3 cm lower calyceal calculi in our hospital from January 2017 to September 2022 were retrospectively analyzed.Among them,65 patients were treated with Olympus electronic FURS(FURS group),62 patients were treated with SMP for stone removal(SMP group),and 82 patients were treated with MPCNL(MPCNL group).The one-session stone-free rate(SFR),operation time,hemoglobin decrease at postoperation immediately,rate of postoperative delayed bleeding,postoperative hospital stay,postoperative fever,and hospitalization cost were compared between the three groups.Results There were significant differences in operation time,postoperative hospital stay,hospitalization costs and one-session SFR among the three groups(P<0.05).The one-session SFR in the MPCNL group(89.0%,73/82)was significantly higher than that in the FURS group(72.3%,47/65;P =0.009).The operation time in the MPCNL group was(38.8±7.6)min,significantly shorter than that in the FURS group[(52.3±7.2)min,P =0.000]and the SMP group[(47.5±7.8)min,P =0.001].The hemoglobin decrease at postoperation immediately in the FURS group was(1.5±0.5)g/L,significantly lower than that in the SMP group[(5.0±1.6)g/L,P = 0.000]and MPCNL group[(6.3±1.8)g/L,P =0.000].The postoperative hospital stay in the FURS group was(2.2±0.5)d,significantly shorter than that in the SMP group[(3.5±0.8)d,P =0.000]and the MPCNL group[(5.3±1.4)d,P =0.000].The hospitalization cost of the FURS group was(22 543.4±1600.4)yuan,significantly lower than that of the SMP group[(26 837.7±2003.9)yuan,P =0.000]and the MPCNL group[(26 784.4±2086.9)yuan,P =0.000],but there was no significant difference between the SMP group and the MPCNL group(P =0.869).There was no significant difference in the incidence of postoperative fever among the three groups(χ2 = 0.462,P = 0.784).Conclusions FURS,SMP,and MPCNL are all effective methods for the treatment of 2-3 cm lower calyceal calculi.FURS has the least intraoperative bleeding,the shortest hospital stay,the lowest hospitalization cost,the lowest one-session stone-free rate,and the longest operation time.MPCNL has the shortest operation time,the highest one-session SFR,the most intraoperative bleeding,and the longest hospital stay.

The STAR tool was used to evaluate and analyze the science, transparency, and applicability of Chinese pathology guidelines and consensus published in medical journals in 2022. There were a total of 18 pathology guidelines and consensuses published in 2022, including 1 guideline and 17 consensuses. The results showed that the guideline score was 21.83 points, lower than the overall guideline average (43.4 points). Consensus ratings scored an average of 27.87 points, on par with the overall consensus level (28.3 points). Areas that scored above the overall level were "conflict of interest" and "working groups", while areas that scored below the overall level were "proposals", "funding", "evidence", "consensus approaches" and "accessibility". To sum up, the formulation of pathology guidelines and consensuses in 2022 is not standardized, and the evidence retrieval process, evidence evaluation methods and grading criteria for recommendations on clinical issues are not provided in the formulation process; the process and method for reaching consensus are not provided, the plan is lacking, and registration is not carried out. It is therefore suggested that guidelines/consensus makers in the field of pathology should attach importance to evidence-based medical evidence, strictly follow guideline formulation methods and processes, further improve the scientific, applicable and transparent guidelines/consensuses in the field, and better provide support for clinicians and patients.

OBJECTIVE: To investigate the effects of fecal microbiota transplantation (FMT) on intestinal microbiome and organism in patients with severe pneumonia during the convalescence period. METHODS: A prospective non-randomized controlled study was conducted. From December 2021 to May 2022, patients with severe pneumonia during the convalescence period who received FMT (FMT group) and patients with severe pneumonia during the convalescence period who did not receive FMT (non-FMT group) admitted to the First Affiliated Hospital of Guangzhou Medical University were enrolled. The differences of clinical indicators, gastrointestinal function and fecal traits between the two groups were compared 1 day before and 10 days after enrollment. The 16S rDNA gene sequencing technology was used to analyze the changes of intestinal flora diversity and different species in patients with FMT before and after enrollment, and metabolic pathways were analyzed and predicted by Kyoto Encyclopedia of Genes and Genomes database (KEGG). Pearson correlation method was used to analyze the correlation between intestinal flora and clinical indicators in FMT group. RESULTS: The level of triacylglycerol (TG) in FMT group was significantly decreased at 10 days after enrollment compared with before enrollment [mmol/L: 0.94 (0.71, 1.40) vs. 1.47 (0.78, 1.86), P < 0.05]. The level of high-density lipoprotein cholesterol (HDL-C) in non-FMT group was significantly decreased at 10 days after enrollment compared with before enrollment (mmol/L: 0.68±0.27 vs. 0.80±0.31, P < 0.05). There were no significant differences in other clinical indexes, gastrointestinal function or fecal character scores between the two groups. Diversity analysis showed that the α diversity indexes of intestinal flora in FMT group at 10 days after enrollment were significantly higher than those in non-FMT group, and β diversity was also significantly different from that in non-FMT group. Differential species analysis showed that the relative abundance of Proteobacteria at the level of intestinal flora in FMT group at 10 days after enrollment was significantly lower than that in non-FMT group [8.554% (5.977%, 12.159%) vs. 19.285% (8.054%, 33.207%), P < 0.05], while the relative abundance of Fusobacteria was significantly higher than that in non-FMT group [6.801% (1.373%, 20.586%) vs. 0.003% (0%, 9.324%), P < 0.05], and the relative abundance of Butyricimonas, Fusobacterium and Bifidobacterium at the genus level of the intestinal flora was significantly higher than that in non-FMT group [Butyricimonas: 1.634% (0.813%, 2.387%) vs. 0% (0%, 0.061%), Fusobacterium: 6.801% (1.373%, 20.586%) vs. 0.002% (0%, 9.324%), Bifidobacterium: 0.037% (0%, 0.153%) vs. 0% (0%, 0%), all P < 0.05]. KEGG metabolic pathway analysis showed that the intestinal flora of FMT group was changed in bisphenol degradation, mineral absorption, phosphonate and phosphinate metabolism, cardiac muscle contraction, Parkinson disease and other metabolic pathways and diseases. Correlation analysis showed that Actinobacteria and prealbumin (PA) in intestinal flora of FMT group were significantly positively correlated (r = 0.53, P = 0.043), Bacteroidetes was positively correlated with blood urea nitrogen (BUN; r = 0.56, P = 0.029) and complement C3 (r = 0.57, P = 0.027), Firmicutes was positively correlated with BUN (r = 0.56, P = 0.029) and complement C3 (r = 0.57, P = 0.027), Fusobacteria was significantly positively correlated with immunoglobulin M (IgM; r = 0.71, P = 0.003), Proteobacteria was significantly positively correlated with procalcitonin (PCT; r = 0.63, P = 0.012) and complement C4 (r = 0.56, P = 0.030). CONCLUSIONS FMT can reduce TG level, reconstruct intestinal microecological structure, change body metabolism and function, and alleviate inflammatory response by reducing the relative abundance of harmful bacteria in patients with severe pneumonia during the convalescence period.
Humans ; Fecal Microbiota Transplantation ; Complement C3 ; Convalescence ; Prospective Studies ; Feces

OBJECTIVE To evaluate the cost -effectiveness of tislelizumab in the second -line treatment of advanced or metastatic esophageal squamous cell carcinoma （ESCC）in China .METHODS A three -state Markov model was constructed to assess the cost -effectiveness of tislelizumab versus chemotherapy in the second -line treatment of advanced or metastatic ESCC and programmed death receptor 1（PD-L1）positive patients . The cycle length of the model was 1 month，and the time horizon of the model was set as 10 years. The discount rate of cost and utility was 5%. One-way sensitivity analysis ，probability sensitivity analysis and scenario analysis were used to verify the robustness of the base -case analysis results . RESULTS The results of the base-case analysis showed that compared with chemotherapy ，the incremental cost -effectiveness ratio （ICER）of tislelizumab in the second-line treatment of advanced or metastatic ESCC and PD -L1-positive patients were 26 864.01 yuan/QALY and 37 510.07 yuan/QALY，respectively，which was much lower than 1 time per capita gross domestic product （GDP）in 2021（80 976 yuan）. Results of scenario analysis showed that the ICER was less than 1 times per capita GDP ，regardless of the chemotherapy regimens（paclitaxel，docetaxel or irinotecan ）used. With the extension of the simulation time limit ，the ICER of tirelizumab regimen gradually decreased ，and the reduction rate gradually E-mail：lishunping@sdu.edu.cn decreased，but they were all less than 1 time China ’s per capita GDP in 2021. The results of the one -way sensitivity analysis showed that the 3 parameters with the most significant impact on the ICER were progression -free survival of tislelizumab group ，price of tislelizumab ，and the proportion of patients receiving follow-up treatment in the tislelizumab group . The results of the probability sensitivity analysis showed that the probability of tislelizumab with cost -effectiveness in the treatment of advanced or metastatic ESCC patients and PD -L1-positive patients were 99.09% and 99.94%，respectively，when using 3 times per capita GDP as the willingness -to-pay threshold . CONCLUSIONS Tislelizumab has economic advantages over chemotherapy alone in the second -line treatment of advanced or metastatic ESCC patients.

Objective:To assess the association between blood pressure and the risks of diabetes mellitus.Methods:Screening and intervention were conducted from 2015 to 2019 for high-risk subjects of cardiovascular diseases in eight counties of Henan. Information on demographic characteristics, lifestyle behaviors, and anthropometric measurements were obtained via a questionnaire. Fasting blood samples were collected for blood glucose and serum lipids. The R 3.6.3 software was used to analyze the relationship between blood pressure and diabetes mellitus.Results:The detection rate of diabetes mellitus was 23.5% among 120 040 participants aged 35-75 years. The mean fasting blood glucose level was significantly different among normotensive, prehypertensive, and hypertensive patients. Compared to normotensive patients, prehypertension and hypertension had adjusted ORs of 34%( OR=1.34, 95 CI%: 1.30-1.37) and 85%( OR=1.85, 95 CI%: 1.81-1.89). The corresponding ORs were 1.81(1.77-1.85) in controlled and 2.17(2.06-2.28) in uncontrolled patients. A subgroup analysis showed the same trend, where the risk of diabetes increased with blood pressure ( P<0.05). Conclusions:People with elevated BP may increase their risk of diabetes, while the risk declines when BP is under control. Therefore, targeted measures should be taken to reduce the risk.

Objective:To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery.Methods:A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People′s Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy.Results:The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases.Conclusions:For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

Objective To analyze the infection rate of hepatitis B virus (HBV) in aggressive B-cell non-Hodgkin lymphoma (B-NHL), indolent B-NHL and multiple myeloma (MM) and its relationship with clinicopathological features. Methods The clinical data of 293 aggressive B-NHL, 181 indolent B-NHL and 261 MM patients in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2017 were retrospectively analyzed. The difference of HBV infection was compared among three groups. Serum samples from all patients were tested for HBV markers, including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb) and hepatitis B core antibody (HBcAb) by using chemiluminescence immunoassay. Results The positive rate of HBsAg was 9.2% (27/293), 5.5% (10/181) and 3.8% (10/261), respectively in the aggressive B-NHL group, indolent B-NHL group and MM group. The positive rate of HBsAg in the aggressive B-NHL group was higher than that in the indolent B-NHL group and MM group (χ2＝6.987, P＝0.030), and there was no statistical difference of HBsAg positive rate between the indolent B-NHL group and MM group (P ＞ 0.05). The positive rate of HBsAg, HBeAg, HBcAb in the aggressive B-NHL group was higher than that in the indolent B-NHL group and MM group [4.1% (12/293), 0, 0.8% (2/261); χ2＝ 14.976, P＝ 0.001], and there was no significant difference in the positive rate of HBsAg, HBeAg and HBcAb between the indolent B-NHL group and MM group (P ＞ 0.05). Compared with HBsAg negative aggressive B-NHL patients, HBsAg positive aggressive B-NHL patients showed, higher ratio of stage Ⅲ-Ⅳ [70.4% (19/27) vs. 49.2% (131/266), χ 2 ＝ 4.377, P＝0.036], more frequent involvement of spleen [51.9% (14/27) vs. 23.7% (63/266), χ 2＝ 10.039, P＝ 0.002], more frequent of B symptom [55.6% (15/27) vs. 32.0% (85/266), χ 2 ＝ 6.073, P＝ 0.014], more frequent of elevated total bilirubin [29.6% (8/27) vs. 14.3% (38/266), χ 2 ＝ 4.360, P ＝ 0.037] and more frequent of reduced albumin [55.6% (15/27) vs. 35.7% (95/266), χ 2＝ 4.115, P＝ 0.042]. Conclusions The infection rate of HBV in aggressive B-NHL patients is higher than that in the indolent B-NHL and MM patients. HBsAg positive aggressive B-NHL patients are associated with adverse clinical characteristics.

Objective To explore the effect Tiaoli-Qixue decoction on bleeding and coagulation during perioperative period of total hip arthroplasty (THA).Methods A total of 180 THA patients who met the inclusion criteria were randomly divided into three groups with 60 cases in each group.All patients underwent routine anti-infection treatment after unilateral THA through lateral hip approach.The patients took the Tiaoli-Qixue decoction 3 days before THA in the treatment group.The patients in the Xuesaitong control group received intravenous Xuesaitong on the day of operation and rivaroxaban tablets were administered orally on the day of operation in the westem medicine control group.The continuous medication was administered until 7 days after operation in three groups.The amount of hemorrhage and drainage after operation were recorded and the total amount of dominant hemorrhage was calculated.The Degao M4 semi-automatic hemagglutination instrument was used to detect plasma D-dimer level and observe thrombosis.Harris scale was used before and after operation to calculate the excellent and good rates of Harris score.Results The total amount of dominant hemorrhage (376.67 ± 61.44 ml vs.400.08 ± 61.16 ml,413.33 ± 53.76 ml,F=5.963),intraoperative hemorrhage (165.50 ± 15.67 ml vs.174.75 ± 14.68 ml,175.42 ± 11.13 ml,F=9.452) and postoperative drainage (211.17 ± 58.12 ml vs.225.33 ± 56.93 ml,237.92 ± 54.28 ml,F=3.370) in the treatment group of traditional Chinese medicine were significanlty less than those in the Xuesaitong control group and the Western medicine control group (P＜0.01 or P＜0.05).On the 7th day after operation,there were 6 cases of thrombosis in the treatment group of traditional Chinese medicine,4 cases in the Xuesaitong control group and 4 cases in the Western medicine control group.There was no significant difference between the three groups (x2=0.667,P=0.881).Six months after operation,the excellent and good rate of that the treatment group of traditional Chinese medicine was 45.0％ (27/60),which of the the Xuesaitong control group was 11.7％ (7/60),and which of the the Western medicine control group was 13.3％ (8/60).There was significant difference among the three groups.Conclusions The Tiaoli-Qixue decoction bleeding and coagulation can reduce the amount of dominant bleeding during perioperative period in patients with THA,and effectively prevent and treat deep venous thrombosis of lower limbs after THA.