OBJECTIVE From the perspective of China’s healthcare system， to evaluate the cost-effectiveness of amivantamab combined with chemotherapy versus chemotherapy alone for patients with EGFR-mutated advanced non-small cell lung cancer （NSCLC） who experience disease progression during or after treatment with osimertinib monotherapy. METHODS The Markov model was established according to MARIPOSA-2 clinical trial. The simulation time limit was 10 years and the cycle period lasted for 21 days. The incremental cost-effectiveness ratio（ICER） of amivantamab combined with chemotherapy versus chemotherapy alone for the treatment of EGFR-mutated advanced NSCLC was calculated， and then compared with the willingness-to-pay（WTP） threshold set in this study[3 times the per capita gross domestic product（GDP） of China in 2023， which was 268 200 yuan per quality-adjusted life year（QALY）]， in order to assess its cost-effectiveness. Single-factor sensitivity analysis and probability sensitivity analysis were performed to evaluate the stability of the model； scenario analysis was carried out to determine the potential price of amivantamab at which the regimen became cost-effective. RESULTS Compared with chemotherapy alone， the cost of amivantamab combined with chemotherapy was higher （1 248 411.60 yuan vs. 89 023.39 yuan）， but at the same time， there were also more benefits of survival （0.756 QALY vs. 0.584 QALY）， ICER was 6 757 285.38 yuan/QALY. ICER was most affected by the utility of progression-free survival and the price of amivantamab. The price of amivantamab decreased to 310.3 yuan per 350 mg， and the combination therapy became cost-effective， compared with chemotherapy alone. CONCLUSIONS From the perspective of Chinese health system， when the WTP threshold is set at three times the per capita GDP of the Chinese population in 2023， amivantamab combined with chemotherapy is not cost-effective for EGFR-mutated advanced NSCLC； the patients’ affordability can be improved when the price of amivantamab experiences a significant decrease.

OBJECTIVE To systematically evaluate the efficacy and safety of Insulin degludec and liraglutide injection （IDegLira） and Insulin glargine and lixisenatide injection（iGlarLixi） in the treatment of type 2 diabetes mellitus（T2DM）， and provide an evidence-based basis for the clinical treatment of T2DM. METHODS Computerized searches of PubMed， Embase， the Cochrane Library， CNKI， Wanfang data and VIP were conducted with a time frame from the inception to August 2024. Randomized controlled trials（RCTs） were rigorously screened according to inclusion and exclusion criteria， from which information was extracted and included studies were evaluated for risk of bias. Network meta-analysis was performed using Stata 14.0 software. RESULTS A total of 15 RCTs， including 9 513 patients， were included， involving four treatment regimens： IDegLira， iGlarLixi， insulin degludec（IDeg）， and insulin glargine（iGlar）. The differences between IDegLira and iGlarLixi were not statistically significant（P＞0.05） for the outcome indexes of glycosylated hemoglobin（HbA1c）， fasting blood glucose， body weight， and the incidence of adverse events（P＞0.05）； for the outcome index of the incidence of hypoglycemic events， IDegLira was significantly superior to iGlarLixi [OR＝0.41，95%CI（0.18，0.91），P＜0.05]. Surface under the cumulative ranking curve（SUCRA） results showed that iGlarLixi（84.5%）＞IDegLira（81.7%） in lowering HbA1c； IDegLira（71.3%）＞iGlarLixi（20.0%） in lowering fasting blood glucose； IDegLira（90.7%）＞iGlarLixi（61.8%） in lowering body weight； IDegLira（95.5%）＞iGlarLixi（9.7%） in reducing the incidence of hypoglycemic events； and IDegLira（27.1%）＞iGlarLixi（14.5%） in reducing the incidence of adverse events. CONCLUSIONS iGlarLixi has better therapeutic efficacy in reducing HbA1c； IDegLira has better therapeutic efficacy in reducing fasting blood glucose and body weight. IDegLira has the lowest risk of hypoglycemia.

Purpose/Significance To analyze the satisfaction,service effectiveness and willingness to participate in telemedicine services from the perspective of medical staff,and to identify the existing problems.Method/Process The research group conducts an e-lectronic questionnaire survey for medical institutions across the country,and collects a total of 1 524 valid questionnaires.Based on questionnaire survey data,logistic regression models are constructed to analyze the key factors that affect the evaluation and attitude of medical staff.Result/Conclusion The overall satisfaction and service effectiveness of medical staff to telemedicine services are at a high level,and their willingness to participate is strong.It is necessary to improve the telemedicine service system and promote the experience of medical staff by strengthening infrastructure construction,optimizing service process,and perfecting incentive mechanisms.

Objective:To discuss the inhibitory effect of Schisandrin B on the proliferation of pancreatic cancer Pan02 cells,and to clarify the mechanism.Methods:CCK-8 method was used to detect the proliferation rates of the Pan02 cells after treated with different concentrations(0,0.78,1.56,3.12,6.25,12.50,and 25.00 mg·L-1)of Schisandrin B to select the optimal concentration and treatment time of Schisandrin B.The mouse pancreatic cancer Pan02 cells were divided into control group(0 mg·L-1 Schisandrin B),2.5 mg·L-1 Schisandrin B group,5.0 mg·L-1 Schisandrin B group,and 10.0 mg·L-1 Schisandrin B group.The morpholoy of Pan02 cells invarious groups was observed with light microscope;5-ethynyl-2'-deoxyuridine(EdU)staining assay was used to detect the positive expression rates of the Pan02 cells in various groups;flow cytometry was used to detect the percentages of the Pan02 cells at different cell cycles and the apoptotic rates of the cells in various groups;Western blotting method was used to detect the expression levels of cell cycle and apoptosis-related proteins in the cells in various groups.Results:The CCK-8 method results showed that after treated with Schisandrin B for 48 and 72 h,compared with 0 mg·L-1 Schisandrin B,the proliferation rates of the Pan02 cells after treated with different concentrations of Schisandrin B were decreased(P<0.01),especially at 72 h.0.25,5.0,and 10.0 mg·L-1 Schisandrin B were selected to treat the Pan02 cells,and 72 h was the treatment time.In control group,the Pan02 cells had a spindle shape,with good condition,and grew closely adhered to the wall with normal organelles and cytoplasm,in 2.5 and 5.0 mg·L-1 Schisandrin B groups,the cell volume was decreased,the intercellular adhesion was disappeared,and the cell membrane was intact but more permeable;the cytoplasm shrank and vacuolar structures appeared inside the cells,with some fragmented and floating on the surface of the solution;in 10.0 mg·L-1 Schisandrin B group,the Pan02 cells exhibited notable apoptotic bodies,indicating an apoptotic state.The EdU staining results showed that compared with control group,the rates of EdU positive cells in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly decreased(P<0.01).The flow cytometry results showed that compared with control group,the percentages of the cells at S phase in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01),while the percentages of the cells at G2/M phase were significantly decreased(P<0.01),and the percentages of the cells at G0/G1 phase in 5.0 amd 1.0 mg·L-1 Schisandrin groups were decreased(P<0.01);compared with control group,the apoptotic rates of the cells in 2.5,5.0,and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01).The Western blotting results showed that compared with control group,the expression levels of p27,B-cell lymphoma 2(Bcl-2)associated X protein(Bax),cleaved cysteine aspartic acid protease-3(cleaved Caspase-3),and cleaved poly adenosine diphosphate(ADP)ribose polymerase(cleaved PARP)proteins in the cells in 2.5 mg·L-1 Schisandrin B group were significantly increased(P<0.05 or P<0.01),the expression levels of cyclin A2,cyclin E2,and Bcl-2 proteins in the cells in 5.0 and 10.0 mg·L-1 Schisandrin B groups were significantly decreased(P<0.05 or P<0.01),while the expression levels of p27,Bax,cleaved Caspase-3,and cleaved PARP proteins in the cells in 5.0 and 10.0 mg·L-1 Schisandrin B groups were significantly increased(P<0.01).Conclusion:Schisandrin B has an inhibitory effect on proliferation of the pancreatic cancer Pan02 cells,and its mechanism may be related to the activation of the cysteine aspartic acid protease-3(Caspase-3)pathway to induce the apoptosis and activating p27 protein to induce the arrest of cell cycle at S phase.

Objective To investigate the correlation between somatosensory evoked potentials(SEP)of upper limbs,and sensory and motor functions in stroke patients in different stages. Methods From June,2021 to October,2023,177 stroke patients in Shijiazhuang People's Hospital were diveded into acute stage group(within 14 days,n=25),early recovery group(14 days to one month,n=110)and middle to late recovery group(one to six months,n=42)according to the duration of the disease.General information of the patients was recorded;SEP examination was performed,and N20 lantency and amplitude were recorded.Monofilament touch and two-point discrimination sensation of the patient's hands were tested using the monofila-ment and two-point discrimination tools,respectively;and motor function was assessed with Fugl-Meyer Assess-ment-Upper Extremities(FMA-UE).The correlation between SEP,and the sensory and motor scores in each group was analyzed. Results There was no significant difference in the monofilament tactile and two-point discrimination scores among the three groups(P>0.05).SEP was not correlated with sensory and motor functions in the acute stage group(P>0.05);in the early recovery group,N20 latency was negatively correlated with monofilament tactile sensation(r=-0.267,P=0.005)and positively correlated with two-point discrimination sensation(r=0.220,P=0.021),and N20 amplitude was positively correlated with monofilament tactile sensation(r=0.328,P<0.001)and FMA-UE score(r=0.418,P<0.001),and negatively correlated with two-point discrimination(r=-0.405,P<0.001);in the middle to late recovery group,the N20 latency was negatively correlated with FMA-UE score(r=-0.313,P=0.044),and N20 amplitude was positively correlated with monofilament tactile sensation(r=0.598,P<0.001)and FMA-UE score(r=0.393,P=0.010),and negatively correlated with two-point discrimination(r=-0.591,P<0.001).Multiple linear regression analyses showed that the score of monofilament tactile sensa-tion was negatively correlated with N20 latency(β=-0.510,P=0.046),and the FMA-UE score was positively correlated with N20 amplitude(β=0.313,P=0.026)in the middle to late recovery group;in the early recovery group,the two-point discriminative sensation score was negatively correlated with N20 amplitude(β=-0.270,P=0.039). Conclusion The correlation between SEP and sensory and motor functions becomes more significant with the prolonga-tion of disease.

Objective:To summarize the experience of unilateral fan-shaped pedicle flap in repairing facial soft-tissue defects.Methods:From September 2015 to September 2018, 20 patients with facial skin and soft-tissue defects were admitted to the 940th Hospital of the Joint Logistic Support Force of the PLA, including 12 males and eight females, aged between five and 40 years old, with an average age of 25 years. On the side of the facial defect, a unilateral fan-pedicled subcutaneous pedicle flap, parallel with the skin lines, was designed to repair the defect in a rotation-advancement way.Results:All the 20 cases survived, and the incision healed in the first stage. All the patients were followed up for three months to 1 year. The facial organs showed no displacement. The scar of the incision was not obvious, and the patients were satisfied with the appearance, which achieved the cosmetic repair effect.Conclusions:To repair the soft-tissue defect around the facial organs, the unilateral fan-shaped pedicle flap is a good choice. It provides a simple and easy method. The damage is slight, the flap blood supply is stable, and the outcome is satisfactory.

Objective:To summarize the experience of unilateral fan-shaped pedicle flap in repairing facial soft-tissue defects.Methods:From September 2015 to September 2018, 20 patients with facial skin and soft-tissue defects were admitted to the 940th Hospital of the Joint Logistic Support Force of the PLA, including 12 males and eight females, aged between five and 40 years old, with an average age of 25 years. On the side of the facial defect, a unilateral fan-pedicled subcutaneous pedicle flap, parallel with the skin lines, was designed to repair the defect in a rotation-advancement way.Results:All the 20 cases survived, and the incision healed in the first stage. All the patients were followed up for three months to 1 year. The facial organs showed no displacement. The scar of the incision was not obvious, and the patients were satisfied with the appearance, which achieved the cosmetic repair effect.Conclusions:To repair the soft-tissue defect around the facial organs, the unilateral fan-shaped pedicle flap is a good choice. It provides a simple and easy method. The damage is slight, the flap blood supply is stable, and the outcome is satisfactory.

Objective:To summarize the effect of Chinese Children′s Cancer Group (CCCG) Wilms tumor (WT)-2015 protocol.Methods:This was a prospective study. CCCG-WT-2015 protocol was revised on the basis of the CCCG-WT-2009 protocol. Clinical data of 288 children diagnosed with newly diagnosed kidney neoplasms in fourteen pediatric centers between September 2015 to December 2018 were summarized. The age of onset, distribution of pathological subtypes, staging, curative effect and prognostic factors of these children were analyzed. Kaplan-Meier method was used for survival curve and Log-Rank method was used for univariate analysis.Results:Among 288 cases with kidney neoplasms, there were 261 cases of WT, including 254 cases (97.3%) with favorable histology (FH) WT and 7 cases (2.7%) with unfavorable histology WT (UFHWT). The 3 year events free survival (EFS) rate for FHWT and UFHWT were (88.9±2.1)% and (80.0±17.9)%, which were better than that in WT-2009 (81.2% and 71.7%). In the 96 cases of stage Ⅲ/Ⅳ FHWT with indications for radiotherapy, 76 cases received radiation, another 20 cases received M protocol chemotherapy (cyclophosphamide, etoposide, gentamycin, vincristine and adriamycin) instead of radiation. The 3 year EFS rate for these two groups were (84.7±4.3)% and (84.7±8.1)%(χ 2=0.015, P=0.902). There were 22 renal clear cell sarcoma and 5 malignant rhabdoid tumor, 3 year EFS rate of them was (94.4±5.4)% and (20.0±17.9)%. Univariate analysis was performed for age, gender, pathological type, stage, whether rupture occurred during operation, whether complete remission (CR) occurred at the end of treatment and radiotherapy. Pathological types (χ 2=44.329, P<0.01) and failure to achieve CR at the end of the treatment (χ 2=49.459, P<0.01) were independent factor for predicting survival. Conclusion:Compared with CCCG-WT-2009, treatment of renal tumors in CCCG-WT-2015 study yielded good survival outcome, which can be further applied.

Objective:To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound.Methods:From February 2015 to February 2019, 22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA, including 17 males and 5 females, aged from 17 to 72 years old, with an average age of 36.4 years old. 6 cases were located in the plantar, 6 in the calf and ankle joints, 5 in the perineum, 2 in the elbow, 2 in the back and 1 in the orbit. Defect area ranged from 5 cm×4 cm to 16 cm×11 cm. Dead space ranged from 3 cm×2 cm to 10 cm×4 cm. 14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap, 5 cases with anterolateral femoral chimeric perforator flap, 1 case with peroneal artery chimeric perforator flap, 1 case with superficial peroneal artery chimeric perforator flap, and 1 case with posterior tibial artery chimeric perforator flap.Results:In the 22 cases of this group, the flap area ranged from 6 cm×5 cm to 17 cm×12 cm, and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm. One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap, which was healed by skin grafting in the second stage after dressing change. One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery. The wound was healed after dressing change and debridement. All the other 20 cases survived well. The patients were followed up for 3-18 months, and the appearance and function of the wound were recovered satisfactorily.Conclusions:In the chimeric perforator flap with muscle flap, the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time, which is one of the good methods to repair the refractory wound with deep dead space.

Objective:To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound.Methods:From February 2015 to February 2019, 22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA, including 17 males and 5 females, aged from 17 to 72 years old, with an average age of 36.4 years old. 6 cases were located in the plantar, 6 in the calf and ankle joints, 5 in the perineum, 2 in the elbow, 2 in the back and 1 in the orbit. Defect area ranged from 5 cm×4 cm to 16 cm×11 cm. Dead space ranged from 3 cm×2 cm to 10 cm×4 cm. 14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap, 5 cases with anterolateral femoral chimeric perforator flap, 1 case with peroneal artery chimeric perforator flap, 1 case with superficial peroneal artery chimeric perforator flap, and 1 case with posterior tibial artery chimeric perforator flap.Results:In the 22 cases of this group, the flap area ranged from 6 cm×5 cm to 17 cm×12 cm, and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm. One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap, which was healed by skin grafting in the second stage after dressing change. One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery. The wound was healed after dressing change and debridement. All the other 20 cases survived well. The patients were followed up for 3-18 months, and the appearance and function of the wound were recovered satisfactorily.Conclusions:In the chimeric perforator flap with muscle flap, the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time, which is one of the good methods to repair the refractory wound with deep dead space.