OBJECTIVE To analyze clinical switching patterns and reasons between bevacizumab biosimilar and originator drugs. METHODS The data were collected from 1 175 cancer patients treated with bevacizumab at Ruijin Hospital， Shanghai Jiao Tong University School of Medicine from January 1， 2018， to December 31， 2023. The patients were divided into originator group （n＝250） and biosimilar group （n＝925）. The switching rate， switching type and reasons of the two groups were compared. RESULTS There were no statistically significant differences in the switching rate， switching types， and the number of switches between the two groups （P＞0.05）. Single， one-way switches were the switching type in both groups. The proportion of patients in the biosimilar group who switched due to adverse events was significantly higher than originator group， while the proportion of patients who switched due to treatment costs was significantly lower than originator group （P＜0.05）. There were no statistically significant differences in the proportions of patients who switched due to efficacy and drug accessibility between the two groups （P＞0.05）. CONCLUSIONS The switching between bevacizumab biosimilar and the originator drugs mainly involves single， one- way switches. Treatment costs and drug accessibility are the main factors for the switches among users of originator drugs， while drug accessibility and adverse events are the main factors for the switches among users of biosimilar.

Objective To analyze the application effects of artificial intelligence (AI) software and Mimics software in preoperative three-dimensional (3D) reconstruction for thoracoscopic anatomical pulmonary segmentectomy. Methods A retrospective analysis was conducted on patients who underwent thoracoscopic pulmonary segmentectomy at the Second People's Hospital of Huai'an from October 2019 to March 2024. Patients who underwent AI 3D reconstruction were included in the AI group, those who underwent Mimics 3D reconstruction were included in the Mimics group, and those who did not undergo 3D reconstruction were included in the control group. Perioperative related indicators of each group were compared. Results A total of 168 patients were included, including 73 males and 95 females, aged 25-81 (61.61±10.55) years. There were 79 patients in the AI group, 53 patients in the Mimics group, and 36 patients in the control group. There were no statistical differences in gender, age, smoking history, nodule size, number of lymph node dissection groups, postoperative pathological results, or postoperative complications among the three groups (P>0.05). There were statistical differences in operation time (P<0.001), extubation time (P<0.001), drainage volume (P<0.001), bleeding volume (P<0.001), and postoperative hospital stay (P=0.001) among the three groups. There were no statistical differences in operation time, extubation time, bleeding volume, or postoperative hospital stay between the AI group and the Mimics group (P>0.05). There was no statistical difference in drainage volume between the AI group and the control group (P=0.494), while there were statistical differences in operation time, drainage tube retention time, bleeding volume, and postoperative hospital stay (P<0.05). Conclusion For patients requiring thoracoscopic anatomical pulmonary segmentectomy, preoperative 3D reconstruction and preoperative planning based on 3D images can shorten the operation time, postoperative extubation time and hospital stay, and reduce intraoperative bleeding and postoperative drainage volume compared with reading CT images only. The use of AI software for 3D reconstruction is not inferior to Mimics manual 3D reconstruction in terms of surgical guidance and postoperative recovery, which can reduce the workload of clinicians and is worth promoting.

BACKGROUND AND AIM: Remnant cholesterol (remnant-C) mediates the progression of major adverse cardiovascular events. It is unclear whether remnant-C, and particularly cumulative exposure to remnant-C, is associated with nonalcoholic fatty liver disease (NAFLD). This study aimed to explore whether remnant-C, not only baseline but cumulative exposure, can be used to independently evaluate the risk of NAFLD. METHODS: This study included 1 cohort totaling 21,958 subjects without NAFLD at baseline who underwent at least 2 repeated health checkups and 1 sub-cohort totaling 2,649 subjects restricted to those individuals with at least 4 examinations and no history of NAFLD until Exam 3. Cumulative remnant-C was calculated as a timeweighted model for each examination multiplied by the time between the 2 examinations divided the whole duration. Cox regression models were performed to estimate the association between baseline and cumulative exposure to remnant-C and incident NAFLD. RESULTS: After multivariable adjustment, compared with the quintile 1 of baseline remnant-C, individuals with higher quintiles demonstrated significantly higher risks for NAFLD (hazard ratio [HR] 1.48, 95%CI 1.31-1.67 for quintile 2; HR 2.07, 95%CI 1.85-2.33 for quintile 3; HR 2.55, 95%CI 2.27-2.88 for quintile 4). Similarly, high cumulative remnant-C quintiles were significantly associated with higher risks for NAFLD (HR 3.43, 95%CI 1.95-6.05 for quintile 2; HR 4.25, 95%CI 2.44-7.40 for quintile 3; HR 6.29, 95%CI 3.59-10.99 for quintile 4), compared with the quintile 1. CONCLUSION Elevated levels of baseline and cumulative remnant-C were independently associated with incident NAFLD. Monitoring immediate levels and longitudinal trends of remnant-C may need to be emphasized in adults as part of NAFLD prevention strategy.
Adult ; Humans ; Cohort Studies ; Non-alcoholic Fatty Liver Disease/etiology* ; Cholesterol ; Proportional Hazards Models ; Risk Factors

Objective To understand the current status of health literacy among caregivers of patients with liver cancer and its influencing factors so as to provide a basis for improving the level of health literacy among caregivers of patients with liver cancer.Methods Using convenience sampling method,the caregivers of the liver cancer patients,who were admitted to the Department of Interventional Radiology of a certain grade ⅢA hospital in Changsha City,Hunan Province of China between April and October of 2022 and who met the inclusion and exclusion criteria,were selected as the research objects.The general information questionnaire,Health Literacy of Caregivers Scale-Cancer(HLCS-C),and Simplified Coping Style Questionnaire(SCSQ)were used to conduct the survey.Multiple linear regression analysis was used to analyze the factors influencing the health literacy among caregivers of patients with liver cancer.Results A total of 204 valid questionnaires were collected.The score of health literacy of caregivers was(123.08±16.66)points.The results of multiple linear regression analysis showed that the residence location,the monthly income per capita of the family,the number of hospitalization times,the length of care,work/study status,and coping style were the main factors influencing the health literacy(P<0.001),which explained 81.9％of the total variance.Conclusion The health literacy among the caregivers of patients with liver cancer is at a moderate level.Clinical medical staff can implement individualized health education by evaluating caregivers with different characteristics,encourage caregivers to seek and grasp disease-related information,and help the caregivers to adopt positive coping styles,so as to improve their health literacy.

The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.

Objective:To compare the effect of immediate and delayed post-space preparation on apical sealing ability between 2 root canal obturation techniques.Methods:60 freshly extracted single-rooted human premolars were collected and instrumented by M3-Pro instruments.The specimens were randomly divided into 6 groups and respectively treated by AH-Plus sealer with warm vertical compac-tion(WVC)followed by delayed post-space preparation(PSP)(A1);AH-Plus sealer with WVC followed by immediate PSP(A2);AH-Plus sealer with WVC,control group(A3);iRoot SP sealer with single cone(SC)followed by delayed PSP(B1);iRoot SP sealer with SC followed by immediate PSP(B2);iRoot SP sealer with SC,control group(B3).In group A1,A2,B1 and B2,gutta percha was removed by 1# starter drill and post-space was prepared by 2# finishing drill leaving 5 mm of apical filling.In control groups(A3 and B3),only apical 5 mm of the specimens was obturated.Dye leakage was measured as the linear penetration(LP)of the stain.The SPSS one-way analysis of variance test was used for statistical analysis.Results:The LP(mm)of group A1,A2,A3,B1,B2 and B3 was 3.986±0.500,3.382±0.806,2.178±0.554,3.844±0.877,3.416±0.579 and 1.897±0.217 respectively.Among A1,A2 and A3 groups,P＜0.05.The LP of group A1 was higher than that of group A2(P＜0.05).Among group B1,B2 and B3,P＜0.05,but be-tween group B1 and B2,P＞0.05.Between group A1 and B1,P＞0.05.Between A2 and B2,P＞0.05.Conclusion:Apical sealing is affected by PSP with the 2 root obturation techniques.Delayed PSP may have negative effect on apical sealing compared with immediate PSP,especially in the specimens compacted by AH-Plus sealer with WVC.

Objective To construct a pelvic floor muscle training program for patients undergoing radical prostatectomy,and to provide a reference for clinical practice.Methods The evidence related to pelvic floor muscle training in patients undergoing radical prostatectomy was systematically searched and the quality was evaluated.The draft of pelvic floor muscle training program for patients undergoing radical prostatectomy was constructed based on the KAP theory and it was demonstrated and revised by expert meetings.From February to March 2023,Delphi method was used to determine the final scheme.37 patients were selected as the control group and 38 patients as the experimental group to implement the scheme and evaluate the application effect.Results 2 rounds of Delphi consultations were conducted among 17 experts,and the recovery rate of the questionnaire was 100％.The expert authority coefficient was 0.89.The Kendall harmony coefficients of the importance and feasibility of the second round of consultation were 0.270 and 0.209(P＜0.001).The coefficient of variation of importance and feasibility of items were 0～0.18 and 0～0.20.The final program included 3 first-level items,8 second-level items and 29 third-level items.1 month after surgery,there was no significant difference in urinary incontinence score(P=0.242)and there was significant difference in pelvic floor muscle training compliance(P=0.011)between 2 groups.Conclusion The program was applied preliminary in clinical practice and it was confirmed with scientific and practical meaning,so it can provide a reference for clinical nursing.

Objective:Insulin resistance(IR)is closely associated with atherosclerosis and adverse cardiovascular events.The triglyceride-glucose(TyG)index is an effective indicator for assessing IR.This study aims to explore the relationship between the TyG index and the risk of arterial stiffness progression. Methods:This retrospective cohort study included adults who had undergone at least 2 health examinations with arteriosclerosis testing at the Health Management Medical Center of the Third Xiangya Hospital,Central South University,between January 2012 and December 2022.Clinical data were collected.The TyG index was calculated using the formula of ln(triglyceridesxfasting blood glucose/2).The baseline TyG index was assessed as both a continuous variable and as a quartile-based categorical variable.The progression of arteriosclerosis was evaluated by the annual change rate of brachial-ankle pulse wave velocity(baPWV)and the new onset of increased arterial stiffness.Linear regression model and Cox proportional hazard model were used to explore whether the TyG index is an independent risk factor for arterial stiffness progression.Subgroup analyses were performed based on age,gender,body mass index(BMI),and the presence of type 2 diabetes,hypertension,or hyperlipidemia to determine the characteristics of the association between the TyG index and arterial stiffness progression. Results:A total of 4 971 participants were included,with a follow-up period of(3.01±1.98)years.During follow-up,the annual baPWV change rate was(24.94±81.15)cm/s,and 278 cases of new onset of increased aterial stiffness were recorded.After fully adjusting for confounding factors,the baseline TyG index was independently positively correlated with both the annual baPWV change rate(β=17.5,95％CI 9.00 to 25.94,P＜0.001)and the risk of new onset of increased aterial stiffness[hazard ratio(HR)=1.43,95％CI 1.18 to 1.74,P＜0.001]when the TyG index was treated as a continuous variable.When treated as a categorical variable,higher TyG index quartiles were associated with progressively higher baPWV change rates and new onset of increased arterial stiffness(all P＜0.055).In subgroups of participants aged ≥45 years,males,BMI＜28 kg/m2,those with or without hypertension,and those without type 2 diabetes or hyperlipidemia,the baseline TyG index(both continuous and categorical)was significantly associated with new onset of increased arterial stiffness(all P＜0.05),with no significant interactions observed across subgroups(all P＞0.05). Conclusion:The TyG index is independently associated with an increased risk of arterial stiffness progression and may serve as a useful indicator for assessing arterial stiffness progression risk in health check-up populations.

Objective:To systematically review the correlation between frailty and postoperative adverse outcomes in ovarian cancer patients.Methods:The research on frailty and postoperative adverse outcomes in ovarian cancer patients was systematically searched in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biology Medicine. The search period was from database establishment to March 27, 2023. Two researchers independently conducted literature screening, quality evaluation, and data extraction, and conducted Meta-analysis using Stata 15.0 software.Results:A total of 17 studies were included. Meta-analysis showed that frailty increased the risk of total postoperative complications [ OR=1.84, 95% CI (1.53, 2.21), P<0.001], severe postoperative complications [ OR=2.34, 95% CI (1.80, 3.03), P<0.001], postoperative 30 day mortality [ OR=1.96, 95% CI (1.68, 2.28), P<0.001], and decreased overall survival [ OR=1.45, 95% CI (1.24, 1.69), P<0.001] in ovarian cancer patients, and it also increased the risk of Intensive Care Unit (ICU) transfer rate [ OR=2.11, 95% CI (1.97, 2.26), P<0.001], non-home discharge [ OR=1.57, 95% CI (1.48, 1.67), P<0.001], and readmission 30 days after surgery [ OR=1.12, 95% CI (1.03, 1.21), P=0.009]. Subgroup analysis showed that age, frailty assessment tools, and whether or not covariates were corrected had no effect on outcomes. Sensitivity analysis showed that all results were reliable. Conclusions:Frailty is a risk factor for postoperative complications, postoperative 30 day mortality, poor overall survival, ICU transfer rate, non-home discharge, and readmission 30 days after surgery in ovarian cancer patients. However, the research findings still need to be further validated through large-scale prospective cohort studies.

Objective:To screen the differentially expressed genes(DEGs)under high phosphate-induced calcification in the vascular smooth muscle cells(VSMCs)by mRNA high-throughput sequencing technology,and to analyze the key genes and signaling pathways involved in the VSMCs calcification.Methods:The human VSMCs were divided into control group and model group.The cells in model group was exposed to the high-phosphate medium,while the cells in control group were cultured in DMEM supplemented with 10%fetal bovine serum under the same conditions.The VSMCs in two groups,stably transfected,were cultured for 12 d.The morphology of the cells in two groups were observed and photographed under inverted microscope.The DEGs were selected by Hisat2 software,and Gene Ontology(GO)functional and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis were performed by Stringtie software from three aspects,such as biological processes(BP),molecular functions(MF),and cellular components(CC).The calcification of the cells in two groups was observed by Von Kossa staining method.Real-time fluorescence quantitative PCR(RT-qPCR)method was used to analyze the expression levels of alkaline phosphatase(ALP),bone morphogenetic protein 2(BMP2),alpha-smooth muscle actin(α-SMA),tumor protein 53(Tp53),glutathione peroxidase 4(GPX4),ferritin light chain 1(Ftl1),and glycosylphosphatidylinositol-specific phospholipase D1(GPLD1)mRNA in the cells in two groups.Results:Compared with control group,there were 2 524 DEGs in the cells in model group,and there were 1 368 upregulated DEGs and 1 156 downregulated DEGs.Clustering of DEGs between the cells in two groups was distinct.The GO functional and KEGG pathway enrichment analysis results showed that the upregulated DEGs were primarily involved in regulating the microtubule cytoskeleton,cell polarity,protein localization,and cell cycle regulation among BPs;in constructing cell membrane,microtubule organization,chromosomes,and kinetochore among CCs;and functioning in phosphatidylinositol phosphate,Rho GTPase protein binding,transmembrane transport,and protein kinase regulatory activity among MFs.Downregulated DEGs were mainly involved in cytoplasmic translation,protein membrane localization,mRNA metabolism,and protein endoplasmic reticulum localization among BPs;in forming ribosome subunits,cell membrane,and autophagy among CCs;and functioning in single-stranded DNA,ribonucleoprotein complex,growth factor binding,regulating protein kinase activity,and catalytic activity among MFs.Seven signaling pathways were significantly enriched in upregulated genes,most notably in the biosynthesis of glycosylphosphatidylinositol(GPI)anchors;whereas 18 signaling pathways were significantly enriched in the downregulated genes,most notably in ferroptosis.The RT-qPCR results showed that compared with control group,the expression levels of GPX4,Ftl1,and Tp53 mRNA in the cells in model group were significantly decreased(P<0.01),while the expression level of GPLD1 mRNA was significantly increased(P<0.01);compared with control group,the expression level of α-SMA mRNA in the cells in model group was significantly decreased(P<0.01),and the expression levels of ALP and BMP2 mRNA were significantly increased(P<0.01).Conclusion:The VSMCs underwent calcification and normal cells exhibit the DEGs.The key signaling pathways in the calcification induced by high phosphate in the VSMCs include ferroptosis and GPI anchor biosynthesis,mediated primarily through GPX4,Ftl1,Tp53,and GPLD1.