OBJECTIVE To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor （AI） versus AI monotherapy as first-line treatment for hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） metastatic breast cancer， thereby providing evidence-based support for clinical therapeutic decision- making and healthcare policy formulation. METHODS Based on the MECCA trial， a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients’ lifetime. The model outputs included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analyses were performed to validate the robustness of base-case results， while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year， 20-year， and lifetime time horizons. RESULTS With the willingness-to-pay （WTP） threshold set at 1 times China’s 2024 per capita gross domestic product （GDP） （95 749 yuan/QALY）， patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility （0.66 QALYs） while incurring higher costs， with ICER of 27 684.85 yuan/QALY. Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate， drug costs of the capecitabine metronomic chemotherapy combined with AI group， utility value in the progression-free survival state， follow-up costs， and treatment costs in the subsequent stablephase. Probabilistic sensitivity analysis indicated that when the WTP threshold ≥49 250 yuan/QALY， the capecitabine metronomic chemotherapy combined with AI regimen had a 100% probability of being cost-effective. Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year， 20-year， and lifetime study horizons. CONCLUSIONS Under the premise that the WTP threshold is set at 1 times China’s per capita GDP in 2024， capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2－ metastatic breast cancer.

OBJECTIVE To evaluate the cost-effectiveness of sacituzumab tirumotecan （ST） versus chemotherapy treatment physician’s choice （TPC） as second-line and later-line treatment for metastatic triple-negative breast cancer （mTNBC） from the perspective of China’s healthcare system. METHODS A partitioned survival model was constructed based on the OptiTROP-Breast 01 trial， with a cycle length of 4 weeks and a time horizon of 10 years， applying a 5% discount rate. Quality adjusted life year （QALY） and costs were used as outcome measures， and the incremental cost-effectiveness ratio （ICER） of ST versus TPC for second-line and later-line treatment of mTNBC was calculated. Sensitivity analyses were conducted to validate the robustness of the base-case results. RESULTS At a willingness-to-pay threshold （WTP） of 3 times China’s 2024 per capita gross domestic product （GDP） （287 247 yuan/QALY）， patients receiving ST gained incremental utility （0.42 QALY） at a higher cost， yielding an ICER of 205 562.07 yuan/QALY， which was lower than WTP， indicating that ST was more cost-effective compared to TPC. One-way sensitivity analysis revealed that key factors influencing the ICER included the utility value of progression-free survival and the price of ST. Probabilistic sensitivity analysis and scenario analysis showed that the base-case results were robust. CONCLUSIONS From the perspective of China’s healthcare system， at a WTP of 3 times China’s per capita GDP， ST is more cost-effective than TPC as second-line and later-line treatment for mTNBC.

OBJECTIVE To evaluate the cost-utility of benmelstobart combined with anlotinib and chemotherapy as first-line treatment for extensive-stage small cell lung cancer （ES-SCLC） from the perspective of China’s healthcare system. METHODS Based on the data from the ETER 701 study， a partitioned survival model was constructed with a cycle of 3 weeks to simulate the total cost， quality-adjusted life years （QALY）， and incremental cost-effectiveness ratio （ICER） over 10 years for patients with ES- SCLC treated with benmelstobart plus anlotinib and chemotherapy， or chemotherapy alone. One-way sensitivity analysis and probability sensitivity analysis were performed to verify the robustness of the simulation results. The willingness-to-pay （WTP） threshold was set at 3 times the per capita gross domestic product （GDP） of China in 2023， which amounted to 268 074 yuan/QALY. RESULTS Compared with chemotherapy alone， benmelstobart combined with anlotinib and chemotherapy gained 0.438 QALY more at the cost of 403 505.55 yuan more， with an ICER of 922 031.37 yuan/QALY， which was higher than the WTP threshold set in this study. One-way sensitivity analysis showed that benmelstobart’s cost and utility value of the progression-free survival state had a greater impact on the ICER value； probabilistic sensitivity analysis confirmed the robustness of the model； only when the price of benmelstobart was reduced by 75.4%， the combined regimen would be cost-effective. CONCLUSIONS The first-line treatment of ES-SCLC with benmelstobart combined with anlotinib and chemotherapy is not cost-effective from the perspective of China’s healthcare system at present.

OBJECTIVE To evaluate the efficacy， safety and economics of calcium channel modulators in the treatment of diabetic peripheral neuropathic pain （DPNP）， and provide evidence-based evidence for clinical drug selection and decision-making. METHODS PubMed， Embase， Cochrane Library， CNKI， Wanfang data， VIP net， CBM and official websites of foreign health technology assessment （HTA） institutions were systematically searched to collect HTA reports， systematic review/meta-analyses， and pharmacoeconomic studies of pregabalin， gabapentin， crisugabalin， and mirogabalin for the treatment of DPNP. The timeframe for all searches was from the inception to June 2024. After data extraction and quality assessment， the results of the included studies were analyzed descriptively. RESULTS A total of 16 articles were included， involving 1 HTA report， 7 systematic reviews/meta- analyses， and 8 pharmacoeconomic studies. No studies on crisugabalin were retrieved. Compared with placebo， both pregabalin and mirogabalin reduced end point pain scores and increased the proportion of patients with ≥30% and/or ≥50% reduction in pain scores. Pregabalin also improved patient global impression of change （PGIC）. Gabapentin was similar to placebo in reducing end point pain scores and increasing the proportion of patients with ≥30% and/or ≥50% reduction in pain scores， but gabapentin improved PGIC of patients. Compared with pregabalin， mirogabalin was more effective in the treatment of pain. The safety of pregabalin and mirogabalin was similar， and compared with placebo， both pregabalin and mirogabalin increased the risk of common adverse reactions such as dizziness and somnolence. The safety of gabapentin was similar to placebo and duloxetine. Compared with duloxetine， pregabalin and gabapentin were not cost-effective. Compared with gabapentin， pregabalin was cost-effective. Mirogabalin was cost-effective， as compared with placebo and pregabalin. CONCLUSIONS Pregabalin and mirogabalin are effective in the treatment of DPNP， the efficacy of mirogabalin is better than pregabalin， and the safety is similar between them. The economic conclusions vary from country to country， pending a pharmacoeconomic study based on our population.

Objective: To explore the neural processing differences in inhibitory control and cognitive flexibility associated with motor development levels in preschool children, so as to provide a basis for motor learning and cognitive development in preschool children. Methods: From March 20 to 31 in 2023, a total of 84 preschool children aged 4-6 were recruited from two kindergartens in Xi an City. The MOBAK-KG Motor Development Assessment Scale was used to assess the children s motor development levels. The Go/no go task paradigm was employed to test inhibitory control ability, and the Dimensional Change Card Sort (DCCS) task paradigm was utilized to evaluate cognitive flexibility. Functional near infrared spectroscopy (fNIRS) was used to monitor the preschool children s prefrontal cortex oxygenation dynamics during inhibitory control and cognitive flexibility tasks. Malab software and Homer 2 plugins were used to calculate prefrontal oxygenated hemoglobin concentration of preschool children during the tasks. Results: The high motor skills group exhibited significantly higher task accuracy during inhibitory control and cognitive flexibility tasks [0.95(0.92, 0.97),(0.54±0.12)] compared to the low motor skill group[0.93(0.85, 0.97),(0.45±0.13)] ( Z/t =-2.09, 3.14 , P <0.05). During the inhibitory control task, the high motor skill group [0.24(0.10,0.41), 0.34(0.16,0.62), 0.30(0.07, 0.52 ), 0.26(0.09, 0.53), 0.15(0.01, 0.43), 0.34(0.10, 0.67)mol/L] showed significantly higher oxygenated hemoglobin concentrations in the left and right dorsolateral prefrontal cortices (L-DLPFC, R-DLPFC), left and right pars triangular Broca s areas ( L- PTBA, R-PTBA), and left and right frontopolar areas (L-FPA, R-FPA) compared to the low motor skill group [0.04( -0.13 , 0.15), 0.00(-0.12, 0.11), -0.01(-0.17, 0.14), 0.04(-0.14, 0.16), -0.01(-0.16, 0.12), -0.03(-0.21, 0.15) mol/L ] ( Z=-4.83, -5.57, -4.77, -4.10, -3.45, -5.74, P ＜0.01). During the cognitive flexibility task, the high motor skill group[0.21(0.03, 0.36), 0.28(0.15, 0.45), 0.15(0.05, 0.30), 0.20(0.05, 0.37), 0.04(-0.17, 0.26), 0.14(-0.08, 0.40) mol/L ] exhibited significantly higher oxygenated hemoglobin concentrations in the L-DLPFC, R-DLPFC, L-PTBA, R-PTBA, L- FPA, R-FPA brain regions compared to the low motor skill group [0.02(-0.20, 0.23), 0.02(-0.12, 0.21), 0.00(-0.22, 0.16 ), 0.00(-0.16, 0.15), -0.05(-0.25, 0.06), 0.01(-0.23, 0.20)mol/L] ( Z=-3.63, -4.45, -3.58, -3.75, -2.18, -1.98 , P ＜0.05). Conclusions The motor development level in preschool children is closely related to inhibitory control and cognitive flexibility. It is crucial to emphasize motor learning in early childhood to further promote holistic development of both mind and body.

OBJECTIVE To evaluate the cost-effectiveness of tislelizumab combined with chemotherapy as first-line treatment for locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma. METHODS The data of RATIONALE-305 study and related literature were used to establish a partitioned survival model from the perspective of China’s health system. The cycle was 3 weeks， the simulation time was set as 10 years， and the discount rate was 5%. The quality-adjusted life years （QALYs） were used as the health outcome indicator to evaluate the cost-effectiveness of tislelizumab combined with chemotherapy versus placebo combined with chemotherapy as first-line treatment for locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma， and one-way sensitivity analysis and probabilistic sensitivity analysis were also conducted. RESULTS The base analysis showed that the patients received more 0.268 QALYs with tislelizumab plus chemotherapy， compared with placebo plus chemotherapy， but the cost increased by 70 404.81 yuan with an incremental cost- effectiveness ratio （ICER） of 262 431.62 yuan/QALY， which was less than three times China’s gross domestic product （GDP） per capita in 2023 as the willingness-to-pay （WTP） threshold （268 074 yuan/QALY）. One-way sensitivity analysis showed that the efficacy value of progress free survive and the price of tislelizumab had a greater impact on the ICER value. The results of probability sensitivity analysis showed that when the WTP threshold was 3 times China’s GDP per capita in 2023， the probability of tislelizumab being cost-effective was 53.3%. CONCLUSIONS When the WTP threshold is 3 times China’s GDP per capita in 2023， tislelizumab plus chemotherapy is cost-effective for first-line treatment of locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma， compared with placebo plus chemotherapy.

Objective:To search, evaluate and summarize the best evidence summary of perioperative accelerated rehabilitation nursing for patients undergoing hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing.Methods:Evidence-based nursing methods were used to search for relevant databases such as BMJ Best Practice, UpToDate, PubMed, CINAHL, and CNKI, etc.. The search period was from December 2010 to December 2022. Four researchers independently evaluated the quality of the guidelines, and two researchers independently evaluated the quality of expert consensus and system evaluation. Finally, the included literature was summarized.Results:A total of 12 pieces of literature, 3 guidelines, 5 expert consensus and 4 systematic reviews were included. From 13 aspects of preoperative education, preoperative optimization, anesthesia management, perioperative blood management, perioperative pain management, perioperative fluid management, perioperative temperature protection, infection prevention, thrombus prevention, postoperative nausea and vomiting, postoperative drainage, functional exercise, and perioperative rehabilitation promotion, 35 pieces of the best evidence for hip and knee replacement patients to accelerate rehabilitation nursing in the perioperative period was summarized.Conclusions:This study summarizes the best evidence of accelerated rehabilitation nursing in the perioperative period of hip and knee arthroplasty, aiming to build and standardize the accelerated rehabilitation nursing scheme in the perioperative period of hip and knee arthroplasty, so as to provide reference for clinical perioperative nursing.

BACKGROUND:Among the surface modification technologies of metal implants,micro-arc oxidation has been widely concerned for its convenience,low cost and ability to effectively adjust the microstructure and elements of surface coatings. OBJECTIVE:To summarize research advances in physical and chemical properties and biological activities of oxidation coatings prepared by micro-arc oxidation on different materials. METHODS:The articles about the effects of micro-arc oxidation on the biological activity of medical metals were searched in PubMed and Web of Science based on the English search terms"MAO,micro-arc oxidation,osseointegration,mechanical property,biological activity,angiogenesis,fibrogenesis".The search time was from January 2016 to December 2022.According to the inclusion and exclusion criteria,82 articles were finally retained for review. RESULTS AND CONCLUSION:Micro-arc oxidation is a potential surface modification technology,which can greatly improve the success rate of implantation,and can be widely used in other fields.The specific reasons are as follows:(1)Micro-arc oxidation technology forms special porous morphology on the surface of materials,which can optimize the mechanical properties such as wear resistance and corrosion resistance,contributing to the reduction of the degradation rate of magnesium alloys.(2)Micro-arc oxidation technology can significantly enhance the bioactivity and improve the bioinertness of titanium and titanium alloys through the addition of strontium,hydroxyapatite and other metallic or nonmetallic substances to its porous morphology for helping elevate its osteogenic differentiation,angiogenesis,fibrogenesis and other biological activities.

BACKGROUND:Micro-arc oxidation can effectively add bioactive elements to the metal surface and improve the anti-bacterial and anti-inflammatory properties of biomedical metal materials,so this technology has become one of the hotspots of biomedical materials. OBJECTIVE:To summarize the anti-bacterial and anti-inflammatory properties of surface coatings prepared by the combination of micro-arc oxidation and other surface modification technologies. METHODS:Articles from January 1996 to December 2022 were searched on CNKI,WanFang and PubMed databases using Chinese and English search terms"micro-arc oxidation,antibacterial properties,anti-inflammatory properties,metal implants".After preliminary screening according to inclusion and exclusion criteria,89 articles were retained and summarized. RESULTS AND CONCLUSION:The ceramic layer prepared by micro-arc oxidation can improve the anti-bacterial and anti-inflammatory properties of titanium,magnesium and other alloys.Combination with other surface modification technologies can effectively solve the effect of pores on the surface properties of the alloy,and further improve the biological properties of the oxide film.It has a wide application prospect in orthopedics and dentistry.At present,most studies are limited to metal coatings,and most of them focus on metal elements with good antibacterial properties such as silver and copper,while only a few studies mention non-metallic coatings such as graphene oxide,hydroxyapatite and chitosan.In the future,extensive studies can be conducted on inorganic coatings and polymer coatings,and more combinations of different bioactive elements can also be adopted to improve antibacterial properties.Currently,studies on the inflammation of implant coatings prepared by micro-arc oxidation are mostly limited to the immune system and focused on macrophages,while studies on neutrophils and platelets are scarce.In the future,a variety of advanced technologies should be combined to explore the specific effects of micro-arc oxidation coating on other immune cells and inflammatory cells.

Objective:To explore the influence of different depths of anesthesia under guidance of anesthesia depth detector on the awakening quality of elderly patients with colon cancer after laparoscopic surgery.Methods:A total of 96 elderly patients with colon cancer who underwent surgical resection and admitted to Beijing Changping District Hospital from February 2017 to June 2020 were selected.They were randomly divided into mild anesthesia group,moderate anesthesia group and deep anesthesia group according to the random sampling,with 32 in each group.The bispectral index(BIS)of deep anesthesia group was within 30-39 interval,and the BIS of moderate anesthesia group was within 40-49 interval,and the BIS of mild anesthesia group was within 50-60 interval.The Prince-Henry pain scale scores of patients with different depths of anesthesia under anesthesia depth detector were observed.The stress response-related indicators included adrenocorticotropic hormone(ACTH),cortisol(Cor)and interleukin-6(IL-6)of patients at three different time points:pre operation(S1),intra operation(S2)and post operation(S3)were monitored.Additionally,the differences of the incidences of complications and the cognitive function also were analyzed.Results:The postoperative Prince-Henry pain scores of the three groups of patients with colon cancer showed there were no statistically significant differences among anesthesia groups with different depths(P>0.05).The stress response indicators included ACTH,Cor and IL-6 appeared significant time-dependent changes among anesthesia groups with different depths.The stress response indicators of all groups significantly increased at S2 point,and the ACTH,Cor and IL-6 levels of mild anesthesia group were respectively(13.73±1.63)nmol/L,(269.24±31.46)nmol/L and(83.67±3.44)μg/L,and these of moderate anesthesia group were respectively(18.26±2.52)nmol/L,(242.56±36.75)nmol/L and(109.35±6.44)μg/L,and these of deep anesthesia group were respectively(19.42±2.42)nmol/L,(432.35±31.34)nmol/L and(132.42±2.31)μg/L.There were significant differences in these indicators in same group between S2 point and S1 point(tmild group=7.99,12.48,16.48,tmoderate group=2.19,6.82,3.03,tdeep group=14.21,5.11,20.14,P＜0.05),respectively.The differences of the incidence rates of complication between the mild anesthesia group and the moderate anesthesia group,and between the mild anesthesia and the deep anesthesia group were statistically significant(x2=6.342,5.238,P<0.05),respectively.The MMSE scores 24 hours after surgery indicated that the difference of that between mild anesthesia group and deep anesthesia group,and between moderate anesthesia group and deep anesthesia group were significant(t=4.74,3.77,P<0.05),respectively.Conclusion:The depth of anesthesia has a significant influence on postoperative recovery quality,stress response and cognitive function.Using anesthesia depth detector to adjust the different depth of anesthesia can help to improve the awakening quality of elderly patients with colon cancer post-surgery and reduce the incidence of adverse reactions.