Objective To explore the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in patients with gastric cancers combined with type 2 diabetes mellitus. Methods From January 2004 to December 2009, the level of blood glucose and body weight before operation and 1,3,6 months after operation in 87 gastric cancer combined with type 2 diabetes mellims patients were retrospectively analyzed. These patients underwent different alimentary tract reconstructions,including 48 patients for Billroth I after distal subtotal gastrectomy (group A), 39 patients for esophageal Roux-en-Y jejunostomy after total gastrectomy (group B). Fasting blood glucose (FBG) level and body weight of these patients were compared. Results In group A, change of FBG before and after operation were not significant (P ＞ 0.05 ). The levels of FBG in group B were significantly lower in 1,3,6 months after operation [(6.7 ±0.8), (6.6 ±0.6), (6.8 ±0.7) mmol/L] than that before operation [(9.7 ± 1.4) mmol/L](P＜0.05). The lower value average difference of FBG at 1,3,6 months was significant between group A and group B (P＜0.05 ). In group B, 6 months after operation's total effective rate was 87.2% (34/39). Changes of body weight before and after operation in group A and group B were significant (P ＜ 0.05 ). But between two groups, the changes of body weight between 1,3,6 months and before operation were not significant (P ＞0.05).Conclusions Esophageal Roux-en-Y jejunostomy after total gastrectomy has obvious influence on FBG level in patients with gastric cancers combined with type 2 diabetes mellitus. It takes about 1 month to reveal the effect of operation and has nothing to do with weight loss.

Objective: To investigate the value of computed tomography (CT) texture analysis in differential diagnosis of inflammatory and malignant pulmonary nodules. Methods: The image data of 54 patients with lung cancer and 36 patients with pulmonary inflammatory nodules were retrospectively collected in our hospital. All the patients received chest CT scan. CT texture analysis of entropy, correlation degree and contrast ratio were performed by the MaZda software. The receiver operating characteristic curve (ROC) was established and the area under the curve (AUC) was calculated to evaluate the value of CT texture analysis in differential diagnosis of inflammatory and malignant pulmonary nodules. Results: In the lung cancer group, the value of entropy, correlation degree and contrast ratio were 1.58±0.07, 0.02±0.17 and 8.79±2.59, respectively. In the inflammatory nodules group, the value of entropy, correlation degree and contrast ratio were 1.51±0.04, 0.22±0.16 and 12.53±2.24, respectively. The differences were all statistically significant (P values were 0.008, 0.027, and 0.006, respectively) between two groups. There was not statistically significant difference (P>0.05) in the CT values between the lung cancer group and the inflammatory nodule group based on the non-contrast enhanced CT scan. Meanwhile, there was no statistically significant difference (P>0.05) in the value of entropy, correlation degree or contrast ratio between two groups based on arterial phase or venous phase of contrast enhanced CT. The ROC analysis showed that the AUC in differentiating the lung cancer and inflammatory nodules was 0.821, 0.778 and 0.875, respectively. The AUC of combination of three phases was 0.931, which was higher than the AUC of entropy, correlation degree and contrast ratio respectively (P<0.01). The sensitivity was 88.9%, and the specificity was 87.5%. Conclusion CT texture analysis is a high-potential image analysis method, which can provide more information for the differential diagnosis of benign and malignant pulmonary nodules.

OBJECTIVE To provide insights for enhancing the supply assurance capability of drugs in shortage in China. METHODS By sorting out top-level design ideas for Japan’s stable supply system for pharmaceuticals， this study elaborates on its current policies for stabilizing drug supply. Policy suggestions were proposed for existing challenges in the supply of drugs in shortage in China. RESULTS & CONCLUSIONS To stabilize drug supply， Japan formulated a systematic 3-tier policy framework that ran through pre-prevention， early risk monitoring， and response mechanisms for supply problems. Pre-prevention measures included establishing a graded classification system for stable supply lists， strengthening government control over the drug production process， and implementing a continuous supply system and cessation reporting system for post-market drugs. Early risk monitoring included self-assessing risks in enterprises， disclosing information concerning supply assurance of enterprises， and providing enterprises with price protection and incentives measures. Response mechanisms for supply problems included establishing the mechanism of increasing production and coordinated supply in enterprises， opening fast-track review and approval channels for changes in raw materials， and establishing emergency systems of transferring drugs to supply. To balance supply assurance and strong regulation of drugs in shortage through refining the incentive and regulatory policies for them， it is recommended to refine the criteria for selecting drugs in shortage， strengthen the circulation of information， optimize price management methods， and clarify problem feedback and solving.

To explore the barriers and facilitators of shared decision making, 23 clinicians were selected for semi-structured interviews by purpose sampling and convenience sampling with phenomenological methods in qualitative research, and 7-step of Colaizzi was used to analyze the interview data. Three themes and twelve subthemes were extracted, included: individual factors of doctors (role cognition, perceived outcomes, communication skills, clinical expertise, cognitive bias) , individual factors of patients (general information, lack of disease knowledge, willingness to participate in decision making) and environmental factors (clinical situation, social environment, resources and social influence) . There were many barriers and facilitators in the implementation of doctor-patient shared decision making. It is necessary to scientifically analyze and actively deal with the influence of each factor, and find reasonable countermeasures to promote the clinical implementation of shared decision making.

The cost-effectiveness analysis policy for drugs was institutionalized in Japan since 2019， realizing quantitative adjustment of price across varieties. A hierarchical categorization approach was adopted to select medicines with high expected annual sales. For selected medicines， adjustments were made to the premium and profit components within the existing price structure based on a pre-defined incremental cost-effectiveness ratio （ICER） threshold， effectively resolving the issue of inconsistent criteria and magnitudes caused by subjective judgment. Meanwhile， incentive measures like evaluation exemption or threshold enhancement were granted for specific medicines. Besides， a price adjustment mechanism， which was allowed for upward and downward adjustments， involving tiered ICER threshold and quantified formulas， had been established for the premium and profit components of drug price. In China’s National Reimbursement Drug List （NRDL） access， certain issues remained to be addressed： insufficient clarity in the quantitative mechanism of price formation， incomplete price adjustment measures， and lagging in the communication channels. It is recommended that the following measures could be referred to when further improving the scientificity and fairness of drug pricing during China’s NRDL access， such as enhancing the ICER threshold for medicines catering to special populations， quantifying criteria and extents for price adjustment， granting preferential pricing policies to pharmaceutical companies that present high-quality evidence of effectiveness， preceding communication channels with pharmaceutical companies， as well as exploring a price floor mechanism for the drugs with excessive price reduction.

OBJECTIVE To provide reference for the improvement of the price system of innovative drugs in China. METHODS Based on the current situation of innovative drug healthcare management in China， innovation recognition and price management of innovative drugs in typical countries or regions were compared and analyzed， and the suggestions were put forward to improve the price system of innovative drugs in China. RESULTS & CONCLUSIONS Taiwan of China， Japan， Australia， Germany and the United Kingdom have different practices in recognition and grading of drug innovation， differentiated pricing and subsequent price management. However， the mainstream practice is to identify and grade drugs mostly based on clinical value， differentiate pricing based on the grading， and carry out risk-sharing agreement or active price adjustment to manage the price. Based on the comparative analysis， it is suggested that China should further clarify the connotation and classification of innovation in the management of innovative drugs， apply a variety of pricing methods to promote differentiated management of innovative drugs， explore the introduction of risk-sharing agreements， and further build an active drug price adjustment mechanism to improve the price system of innovative drugs in China.