OBJECTIVE To evaluate the cost-utility of enfortumab vedotin combined with pembrolizumab （PemEV） versus gemcitabine combined with cisplatin or carboplatin （GP） in the first-line treatment of advanced urothelial carcinoma （aUC）. METHODS From the perspective of China’s health system， a dynamic Markov model was established based on the pan-Asian subgroup data from the EV-302 trial. The study timeframe was set at 20 years， with a cycle length of 21 days and a discount rate of 5%. Using total direct medical costs and quality-adjusted life years （QALYs） as outcome measures， the incremental cost- effectiveness ratio （ICER） of the PemEV regimen compared to the GP regimen was calculated. The robustness of the model was validated through sensitivity analysis and scenario analysis， and the price thresholds for enfortumab vedotin and pembrolizumab were estimated under conditions where the PemEV regimen was more cost-effective compared to the GP regimen. RESULTS Cost- utility analysis indicated that compared to the GP regimen， PemEV regimen could generate an additional 2.602 QALYs in aUC patients， but the treatment cost increased by 3 339 703.56 yuan， with an ICER of 1 283 554.39 yuan/QALY. This figure significantly exceeded the willingness-to-pay （WTP） threshold （3 times China’s gross domestic product per capita in 2024， 287 247 yuan/QALY）. The rate parameter of the exponential distribution fitted to the overall survival curve in the PemEV regimen had the greatest impact on ICER， according to the one-way sensitivity analysis. Probabilistic sensitivity analysis suggested that the PemEV regimen had no chance of being more cost-effective than the GP regimen at the current WTP threshold. Scenario analysis revealed that the PemEV regimen consistently lacked cost-utility advantage over the GP regimen， regardless of whether the study model was changed to a partitioned survival model， the study timeframe was set to 5， 10 or 20 years， or the prices of enfortumab vedotin and/or pembrolizumab were reduced by 60%. The prices of enfortumab vedotin and pembrolizumab should be simultaneously reduced by 78.65% （55.71 yuan/mg and 38.26 yuan/mg， respectively） when the PemEV regimen had a cost-utility advantage over the GP regimen. CONCLUSIONS From the perspective of China’s healthcare system， PemEV regimen does not demonstrate a cost-utility advantage over GP regimen in the first-line treatment of aUC.

Tendon-bone healing is a complex biological process. Multiple signaling pathways are involved in tendon-bone healing， including transforming growth factor-β signaling pathway， bone morphogenetic protein signaling pathway， Wnt signaling pathway， fibroblast growth factor signaling pathway and nuclear transcription factor-κB signaling pathway. This paper summarizes the research status of traditional Chinese medicine regulating related signaling pathways to promote tendon-bone healing. It is found that a variety of traditional Chinese medicine monomers or herbal extracts （such as baicalein， icariin， total flavonoids of Drynaria fortunei， parthenolide， total saponins of Panax notoginseng， etc.） and traditional Chinese medicine compounds （such as Taohong siwu decoction， Liuwei dihuang pill， Xujin jiegu liquid， etc.） can promote bone formation， anti-inflammatory， anti-oxidation， by regulating the above signaling pathways， thereby effectively promoting tendon-bone healing.

Objective:To explore the effective components and potential mechanisms of Xiefei Lishui Prescription in the treatment of heart failure.Methods:Ultra high-performance liquid chromatography tandem four stage rod time of flight mass spectrometry (UPLC-Q-TOF-MS) technology was used to analyze and identify the active components of Xiefei Lishui Prescription. Drug targets were predicted through the Swiss Target Prediction database, and disease targets were collected from Gene Cards, Dis GENET, and TTD databases. The intersection of drug targets and disease targets was screened using a STRING database for protein interaction to identify core targets. The core targets were included in the DAVID database for GO enrichment and KEGG analysis. Finally, molecular docking validation was performed between the drug components and the corresponding core targets.Results:The results identified 10 active components of Xiefei Lishui Prescription, and 8 potential active components were screened using network pharmacology for the treatment of heart failure with Xiefei Lishui Prescription, corresponding to 160 related action targets. A total of 1 305 disease-related targets were collected, and a total of 51 targets ad 17 core targets were included in the string database for protein interaction analysis. GO functional enrichment and KEGG analysis indicated that the mechanism of Xiefei Lishui Prescription in treating heart failure may be related to pathways such as protein binding, ATP binding, and negative regulation of the VEGF signaling pathway and T cell receptor pathway during apoptosis. The molecular docking results showed that baicalin exhibited good binding activity with ESR1, sorghum isoflavones with ESR1, and quercetin with AKT1, EGFR, IL2, and ABCB1.Conclusion:Xiefei Lishui Prescription may exert therapeutic effects on heart failure through multiple pathways by targeting ESR1, AKT1, EGFR, and other targets.

Objective To investigate the effect of early combined use of liraglutide on cardiometa-bolic risk factors and prognosis in patients with T2DM and CMVD.Methods A total of 124 T2DM patients with concomitant CMVD admitted in our hospital from May 2021 to June 2023 were enrolled,and divided into the liraglutide group(n=59)and the non-liraglutide group(n=65)according to taking liraglutide or not.The main observation indicators were compared between the two groups,including cardiometabolic risk factors,such as Hcy,UA,FPG,eGFR,HbA1c,hs-CRP,WC,BMI,WWI,and echocardiographic indicators,such as LAD,LVEDD,LVPWT,IVST,E/e',e',LVEF,LAVI,LVMI,and RWT.And the incidence of adverse reactions and read-mission rates were recorded during follow-up.Results After treatment,in the liraglutide group,Hcy,UA,FPG,HbA1c,hs-CRP,WC,BMI,WWI,E/e',LAVI,LVMI,RWT,IVST and LVPWT values,and anteroposterior,transverse and long diameters of left atrium were all lower than before treatment,and eGFR and e'value were increased(P＜0.05,P＜0.01),and no significant difference was seen in LVEF and LVEDD(P＞0.05).The non-liraglutide group obtained lower HbA1c,FPG,BMI,E/e'and LAVI values,and transverse diameter of left atrium,elevated LVPWT and e'value(P＜0.05,P＜0.01),and no obvious changes in Hcy,UA,eGFR,hs-CRP,WC,WWI,BMI,LVEF,LVMI,RWT,LVEDD,IVST,and anteroposterior and long diameters of left atrium when compared with the indicators before treatment(P＞0.05).At the end of the fol-low-up,when compared with the non-liraglutide group,the liraglutide group had more significant decreases in E/e',LAVI,LVMI and RWT values and increase in e'value(P＜0.05,P＜0.01),and higher total effective rates(94.92％vs 72.31％,P＜0.01).What's more,the readmission rate due to adverse cardiovascular events was notably lower in the liraglutide group and the non-liraglutide group(3.39％vs 15.38％,P＜0.05).Conclusion Compared with BMI,WWI may be more sensi-tive in reflecting changes in cardiometabolic risk factors in T2DM patients with CMVD;Early combined application of liraglutide has good efficacy and safety,and exerts multiple cardiovascular protective effects,including reducing cardiometabolic risk factors,improving cardiac diastolic function and renal function,inhibiting chronic inflammation and decreasing the occurrence of ad-verse cardiovascular events in the patients.

Medical and pharmaceutical research laboratories encompass a wide range of study areas.They utilize diverse materials ranging from animals and microorganisms to nanoparticles and other substances.However,as laboratory waste increases,more biosafety risks are created.In this context,we outlined the safety risks associated with gene amplification,gene recombination,research involving pathogenic microorganisms,nanotechnology,animal experiments,genetically modified animals,and experimental waste.Additionally,we here in propose preventive measures to mitigate laboratory biosafety risks.These measures primarily involve the development of strict legal frameworks,improvement of hardware infrastructure,strengthening of safety awareness,and enhancement of education and training programs.

Based on network pharmacology and in vitro assays,we conducted a collaborative investi-gation into the protective effects of ginsenosides Rg1 and Re on LPS-induced damage of porcine je-junal epithelial cells IPEC-J2.Network pharmacology was used to obtain and screen the intersec-ting targets of Rg1 and Re to alleviate intestinal barrier damage,and molecular docking technique was used to verify the predicted results of network pharmacology.The experiment included the Control group,LPS group,Rg1 group,and Re group.The effects of different concentrations of Rg1 and Re on cell survival rate,apoptosis rate,TEER value,FD4 permeability,and inflammatory fac-tors of IPEC-J2 were observed,and the effects of different concentrations of Rg1 and Re on the mRNA expression levels of apoptosis-related genes were also detected by fluorescence quantitative PCR.The results of network pharmacology showed that the prevention of intestinal barrier damage by Rg1,Re mainly involved the processes of PI3K-Akt and MAPK signaling pathways.The molec-ular docking results showed that the binding energy of Rg1 to all intersecting targets was less than 0,while that of ginsenoside Re to SRC targets only was less than 0.In vitro experiments showed that pretreatment with different concentrations of Rg1 and Re increased the survival rate and TEER value of LPS-treated IPEC-J2 to varying degrees,and reduced the apoptosis,the decrease of FD4 permeability,and the secretion of inflammatory factor TNF-α,suggesting that Re and Rg1 prevented the intestinal barrier from damage.It was shown that Re and Rg1 could effectively re-duce the effects of LPS treatment on IPEC-J2 cells.Rg1 significantly upregulated the mRNA ex-pression levels of MAPK8,MAPK10,HRAS,and significantly down-regulated the mRNA expres-sion levels of MAP2K1,PIK3CG,IL-2 and SRC;and Re significantly upregulated the mRNA ex-pression levels of MAPK8,MAPK10,HRAS,and PIK3R1,BCL2 gene mRNA expression levels.These results suggest that ginsenosides Rg1,Re and ginsenoside products containing Rg1 and Re deserve further investigation in preventing intestinal barrier damage in piglets.

Objective:To explore the association between childhood growing environment and depressive symptoms in young old persons aged 60 to 74 years.Methods:The data of the fourth wave of China Health and Re-tirement Longitudinal Study in 2018 and the life course survey in 2014 were used to secondary analysis.A total of 7 642 young old persons aged 60 to 74 years were included,and the 10-item of the Center for Epidemiological Stud-ies Depression(CES-D-10)scale was used to evaluate the depressive symptoms.The generalized linear mixed effects model was used to explore the relationship between childhood growing environment and depressive symp-toms in the young old persons.Results:The detection rate of depressive symptoms occurrence in the young old per-sons was 37.2％.The risk factors of depressive symptoms included female(OR=1.89),rural(OR=1.35),hav-ing hunger experience(OR=1.22),poor relationship with male dependents(OR=1.72),female caregiver's expe-riences of being bedridden due to illness(OR=1.38),community insecurity(OR=1.59),more harmonious neigh-borhood relationship(OR=1.20)and less harmonious neighborhood relationship(OR=1.81).The protective fac-tors of depressive symptoms occurrence included moderate(OR=0.79)and high(OR=0.50)per capita house-hold income,and educated father(OR=0.84)(P＜0.05).Conclusion:Childhood growing environment is an influ-ential factor of depressive symptoms in the young old persons.The long-term health effects of childhood environ-ment should be paid attention to.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To evaluate the clinical efficacy of Yiqi-Tongmai Decoction on isolated coronary muscle bridge angina patients with qi deficiency and blood stasis syndrome. Methods:A total of 64 patients with isolated coronary artery muscular bridge angina pectoris with qi deficiency and blood stasis syndrome in Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from April 2016 to January 2020 who met the inclusion criteria were divided into 2 groups by random number table method, with 32 patients in each group. The control group took diltiazem hydrochloride tablets orally, and the treatment group took Yiqi-Tongmai Decoction on the basis of the control group. Both groups were treated for 8 weeks. The TCM syndrome scores were observed before and after treatment, and Seattle Angina Questionnaire was assessed for patient's quality of life and functional status. The exercise ECG test was observed before and after treatment, and the cause of angina pectoris need to be recorded, including the movement time and plate movement caused by time of ST segment in electrocardiogram (ecg) and dynamic evolution. Results:The total effective rate of angina pectoris was 84.38% (27/32) in the treatment group, and 53.13% (17/32) in the control group, and the difference between the two groups was statistically significant ( χ2=8.09, P<0.05). After treatment, the degree of physical activity limitation (69.24 ± 14.21 vs. 59.42 ± 11.71, Z=-2.61), stable state of angina (82.25 ± 21.24 vs. 69.11 ± 19.52, Z=2.64), angina (80.24 ± 18.31 vs. 69.11 ± 15.54, Z=2.63), treatment satisfaction (86.16 ± 19.23 vs. 61.19 ± 17.35, Z=2.22), degree of disease cognition (74.41 ± 21.13 vs. 60.43 ± 19.42, Z=2.40) scores in the treatment group were significantly higher than those in the control group ( P<0.05). In the treatment group, the time of exercise-induced angina pectoris [(476.15 ± 62.15)s vs. (399.38 ± 78.42)s, Z=-2.08], the time of ST segment descending 1 mm after exercise [(394.54 ± 75.61)s vs. (309.64 ± 81.62)s, Z=-2.40] in the treatment group were significantly longer than those in the control group ( P<0.05). The total effective rate of TCM syndrome was 93.8% (30/32) in the treatment group and 65.6% (21/32) in the control group, and the difference was statistically significant ( χ2=7.96, P<0.05). The TCM syndrome scores of the treatment group (25.15 ± 6.15 vs. 36.38 ± 10.42, Z=-2.56) in the treatment group were significantly lower than that of the control group ( P<0.05). There were no obvious adverse reactions in both groups during treatment. Conclusion:Yiqi-Tongmai Decoction can improve the clinical symptoms of isolated coronary artery muscle bridge angina pectoris with qi deficiency and blood stasis syndrome, reduce the onset of angina pectoris, delay the time of exercise induced angina pectoris, and improve the clinical efficacy.

In recent years, many scholars have explored the clinical application value of a number of peripheral hematology indexes in tumor patients. The significant correlation of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with the prognosis in various tumors has also been confirmed. At present, more peripheral blood indexes have been gradually applied to the evaluation of the prognosis in patients with malignant tumors. Small cell lung cancer (SCLC) is a type of highly malignant tumor and most patients are in advanced stage at the time of diagnosis. The evaluation value of tumor stage for survival is extremely limited. Therefore, this review intends to explain the relationship between various peripheral hematology indexes and the prognosis of SCLC patients, so as to provide some academic evidence for the clinical assessment of the survival of SCLC patients and formulation of appropriate treatment strategy, which may contribute to the improvement of the prognosis.