Latest ArticlesAIM To evaluate the cost-effectiveness of insulin degludec-liraglutide（iDegLira） versus insulin glargine-lixisenatide （iGlarLixi） in Chinese adult type 2 diabetes mellitus （T2DM） patients. METHODS From the perspective of China’s health system, a Markov model was developed. Quality-adjusted life years （QALY） were used as the health output indicator, and three times 2023 gross domestic product （GDP） per capita of China was used as the willingness-to-pay （WTP） threshold. The model simulates the health output and medical costs over 30 years, evaluates the economics of the two treatment options using the incremental cost-effectiveness ratio （ICER） as an evaluation metric, and performs sensitivity and contextual analyses to test the uncertainty of the results. RESULTS Compared with the iGlarLixi scheme,iDegLira scheme had an incremental cost of 46 142.61 yuan, an incremental utility of 0.014 QALY. The ICER was 3 258 162.70 yuan·QALY-1, which was much larger than the WTP threshold （268 074 yuan·QALY-1） and was not cost-effectiveness. The results of the sensitivity analysis show that the underlying analysis was relatively robust. The results of the contextual analysis showed that the cost-effectiveness of the two schemes was comparable when the price was reduced by 31% at the current WTP threshold. CONCLUSION For Chinese adult T2DM patients with poor glycemic control despite receiving basal insulin in combination with oral hypoglycemic agents, iDegLira scheme has a lower probability of being economical at current prices compared with the iGlarLixi scheme.
AIM To analyze the clinical characteristics and influencing factors of dextromethorphan-induced 5-hydroxytryptamine syndrome （5-HTS）. METHODS Relevant cases of dextromethorphan-induced 5-HTS in PubMed,Embase, Cochrane Library, CINAHL, PsycINFO, CNKI, WanFang database, SinoMed, and VIP database were retrieved,and clinical data were summarized and analyzed. RESULTS A total of 16 cases of 5-HTS were collected, including 11 males and 5 females. Dextromethorphan could cause 5-HTS at both normal and excessive doses, and the majority （88%）of patients were co-administered with other 5-hydroxytryptamine drugs. The onset of 5-HTS occurred between 4 hours and 6 weeks after dextromethorphan administration, with symptoms including myoclonus, tachycardia, and fever. After discontinuation of dextromethorphan and other serotonergic drugs, along with supportive therapy, all patients improved.The mean duration of 5-HTS was 26 hours. Patients treated with cyproheptadine had a shorter duration of 5-HTS, averaging 21.6 hours. CONCLUSION Dextromethorphan-induced 5-HTS most often occurs when used in combination with other serotonergic drugs. It is recommended to strengthen management to reduce the abuse of dextromethorphan and unnecessary co-administration, as well as to improve the ability of physicians and pharmacists to recognize and monitor 5-HTS.
Chimeric antigen receptor（CAR）- T cell therapy has changed the traditional treatment of hematological malignancies and has shown significant efficacy. However, the clinical application of CAR-T cells is limited by long production cycle, high price, and side effects such as cytokine storm, so it can not be widely used in clinical practice. Natural killer（NK）cells are an important part of the body’s innate immune response. Compared with CAR-T cells, CAR-NK cells can significantly reduce the probability of neurotoxicity, cytokine storm, and graft versus host diseases. CAR-NK cell therapy is gradually becoming a research hotspot, but there are still some urgent problems to be solved, and further optimization of the construction strategy is needed to achieve its clinical translation. This paper will review the construction strategy and the research progress in tumor immunotherapy based on the latest literatures at home and abroad, in order to provide valuable reference for application of NK cells in the treatment of malignant tumors.
Antibody-drug conjugates（ADCs）consist of monoclonal antibodies, linkers, and cytotoxic drugs,representing a novel class of anti-cancer agents that combine target specificity with chemotherapeutic efficacy. ADCs have demonstrated significant efficacy not only in breast cancer, gastric cancer and lung cancer, and have also shown clinical benefits in ovarian cancer. This review discussed the structure, mechanism, and applications of ADCs in ovarian cancer,aiming to provide new insights for clinical treatment of ovarian cancer.
Integrins play an important role in mediating the entry of lymphocytes into the intestines leading to the development of inflammatory bowel disease（IBD）, and their binding to the corresponding ligands mediates the intestinal homing and retention of lymphocytes. Currently, the anti-integrin drug vedolizumab has been used in clinical practice, and several other anti-integrin drugs are under development, such as abrilumab, AJM300, PTG-100, and milategrast. Clinical studies have shown that gut-selective anti-integrin agents may be a safe and effective option for the treatment of IBD.
Acne vulgaris is one of the most common skin diseases in dermatology. Retinoids are commonly used in the treatment of this disease. Trifarotene is derived from CD437, a triaryl skeleton lead compound with retinoic acid receptor subtype selectivity, after the optimization of receptor structure. It is called the fourth generation retinoic acid anti-acne drug because of its high selectivity for retinoic acid γ receptor（RAR-γ）. In October 2019, trifarotene was approved by the U.S.Food and Drug Administration for the treatment of acne vulgaris in patients aged 9 and above. Clinical trials have shown that trifarotene is safe, effective and well tolerated in the treatment of acne vulgaris, which has a good clinical application prospect.
The Inflation Reduction Act（IRA）took effect in the United States in 2022. For the first time, the IRA allows the federal government to negotiate prescription drug prices, requires pharmaceutical companies to pay rebates to Medicare when prices rise above the rate of inflation, caps patient out-of-pocket costs for Medicare Part D drugs and insulin products, continues the “safe harbor” policy, extends the advance premium tax credit policy, and expands the types of free vaccinations. The IRA has multiple impacts on Medicare drug spending, but it still faces structural pressure in terms of price control. It is suggested that China can continue to utilize the public welfare advantages of basic medical and healthcare services, improve the targeting and operability of relevant health policies,and protect innovation while controlling drug prices.
Chinese materia medica genetic resources are important biological and health resources. With the increasing reliance on Chinese materia medica genetic resources in various fields, bio-piracy against Chinese materia medica genetic resources is becoming more and more frequent and has posed a threat to China’s ecological security and the rights of people’s lives and health. However, the system of the source disclosure of genetic resources established by China’s Patent Law, as well as the use of contractual mechanisms to achieve access to Chinese materia medica genetic resources and benefit-sharing, are both inadequate and unable to effectively deal with the problem of bio-piracy. Therefore, in order to safeguard the rights and interests，China, as a party to the Convention on Biological Diversity and the Nagoya Protocol, should formulate or improve the domestic laws following the legal rules established by the above-mentioned international treaties and China’s national conditions. Related initiatives may include taking the source disclosure as a formal condition for the patent grant, expanding the target and scope of the disclosure, and imposing legal liability for defect disclosure; clarifying the subjects of rights to Chinese materia medica genetic resources, and introducing public authority to “monitor” the signing and implementation of contracts to ensure fair and equitable benefit-sharing.
To investigate the effect of ultrasound-guided lateral quadratus lumborum block（QLB-1）on the median effective dosage（ED50）of butorphanol by patient controlled intravenous analgesia（PCIA）performed after cesarean section under general anesthesia.
Parturients were scheduled for cesarean section under general anesthesia,gestation 37-42 weeks, ASA physical status Ⅱ were assigned into two groups, group Q（QLB-1 combined with butorphanol PCIA）and group C（butorphanol PCIA）. Each group was expected to have 35 cases. Both groups were administered general anesthesia with endotracheal intubation. The group Q: 0.3% ropivacaine with 25 mL were injected in the QLB-1 in each side respectively under ultrasound guidance before extubation at the end of the surgery. The group C: no nerve block.The two groups underwent PCIA after extubation. The scores of resting visual analogue scale（VAS）≤3 points or VAS of motion state ≤4 points within 48 hours after operation were used as the criteria of analgesia satisfaction. The initial dose of butorphanol with PCIA was 4 μg·kg-1·h-1, adjusted by the modified Dixon’s up-and-down method with a dose gradient of 0.25 μg·kg-1·h-1. Probit analysis was used for calculating ED50 and 95% confidence interval（CI）of butorphanol PCIA for satisfactory analgesia.
The sample size included in group Q and group C were 31 and 28 cases, respectively.The ED50 of butorphanol PCIA for satisfactory analgesia was 3.81 μg·kg-1·h-1 for the group C（95%CI: 2.87 to 4.25 μg·kg-1·h-1）and 2.45 μg·kg-1·h-1 for the group Q（95%CI: 2.16 to 2.70 μg·kg-1·h-1）. In the parturients with satisfactory analgesia of the two groups, the incidence of drowsiness, dizziness and nausea was higher in the group C than that in the group Q（P<0.05）.
The ED50 of butorphanol PCIA combined with QLB-1 for satisfactory relieve postoperative analgesia after cesarean section under general anesthesia reduce butorphanol PCIA alone by 36% and reduce the incidence of adverse reactions.
To explore the effects of esmolol on hemodynamics and inflammatory reaction during endoscopic sinus surgery in patients with sinusitis.
Eighty patients with sinusitis undergoing endoscopic sinus surgery were randomly divided into control group and trial group, with 40 patients in each group. The control group received routine anesthesia induction and maintenance, while the trial group received an additional 0.5 mg·kg-1 of esmolol injection during anesthesia induction and 30 μg·kg-1·min-1 of esmolol pump injection during anesthesia maintenance. The blood pressure and heart rate of patients were observed, the levels of interleukin（IL）-6, tumor necrosis factor（TNF）-α and C-reactive protein（CRP）in the blood were detected, and the recovery time, intraoperative blood loss, propofol dosage, remifentanil dosage and postoperative nausea and vomiting rate were compared between the two groups.
The systolic blood pressure, diastolic blood pressure, and heart rate of the trial group were lower than those in the control group at entering the operating room, the time of tracheal intubation, the beginning of surgery, 1 h after the beginning of surgery（T3）, the end of surgery（T4）, and the time of tracheal intubation was removed（P<0.01）. The levels of IL-6, TNF-α and CRP at T3 and T4 in the trial group were also lower than those in the control group（P<0.01）. The recovery time of the trial group was significantly shorter than that of the control group（P<0.01）, and the amount of intraoperative blood loss, propofol and remifentanil was significantly lower than that of the control group（P<0.01）. The incidence of postoperative nausea and vomiting in the trial group was lower than that in the control group（P<0.05）.
Esmolol is beneficial to maintain the stable hemodynamics of patients with sinusitis during endoscopic sinus surgery, can reduce inflammatory reaction, reduce intraoperative blood loss and the dosage of general anesthetics, and is relatively safe.
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