OBJECTIVE To assess the cost-effectiveness of durvalumab combined with chemotherapy as a first-line treatment for advanced biliary tract cancer from the perspective of the Chinese healthcare system. METHODS Using data from the TOPAZ-1 clinical trial， a three-state Markov model comprising progression-free survival （PFS）， progressive disease （PD） and death was developed， with a cycle length of 21 days and a 10-year time horizon. Patients in the observation group received durvalumab in combination with gemcitabine and cisplatin， whereas those in the control group received placebo plus the same chemotherapy regimen. The evaluation indexes were quality-adjusted life year （QALY） and the incremental cost-effectiveness ratio （ICER）. The willingness-to-pay （WTP） threshold was set at three times the 2024 Chinese per capita gross domestic product （GDP） （287 247 yuan/QALY）. The sensitivity analyses， along with scenario analyses， were performed. RESULTS In the base-case analysis， the ICER of observation group compared to control group was 1 166 344.46 yuan/QALY， far exceeding the WTP threshold， indicating that the regimen was not cost-effective. One-way sensitivity analysis identified the PD state utility， discount rate， cost of durvalumab， and PFS state utility as the main drivers of ICER variation. Probabilistic sensitivity analysis showed that， at the above WTP threshold， the probability of the acceeptance of this regimen was 0， further supporting the robustness of the base-case findings. In the scenario analysis， inclusion of a patient assistance program reduced the ICER to 235 885.16 yuan/ QALY， below the above WTP threshold， suggesting cost-effectiveness under this assistance program. However， when applying a regional WTP threshold set at three times the per capita GDP （158 475 yuan/QALY） of Gansu Province （the province with the lowest GDP in China in 2024）， the ICER remained above the threshold， indicating that the regimen was not cost-effective at the regional level. CONCLUSIONS At current pricing， durvalumab plus chemotherapy as a first-line treatment for advanced biliary tract cancer is not cost-effective in China. Although the introduction of a patient assistance program can substantially reduce the ICER and achieve cost-effectiveness at a WTP threshold set at three times the 2024 per capita GDP of China， due to limited affordability in low-income areas， the program remains not cost-effective.

Background Staff in tertiary hospitals are a high-risk group for occupational burnout. Timely identification and precise intervention are crucial for improving healthcare service quality. However, comparative studies on perceived stress and occupational burnout among hospital staff in different positions are lacking. Objective To describe the status of perceived stress and occupational burnout among hospital staff in different positions and compare the differences, explore the relationship between perceived stress and occupational burnout, and identify the influencing factors of occupational burnout. Methods In May 2022, 1526 hospital staff members were selected by convenience sampling from six tertiary hospitals in Guangzhou. Data were collected using a general information questionnaire, the Chinese Perceived Stress Scale (CPSS), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) to assess demographic characteristics, perceived stress, and occupational burnout. Chi-square test, one-way ANOVA, and Kruskal-Wallis H test were used to compare differences in perceived stress and occupational burnout among staff in different positions. Pearson correlation analysis was used to explore possible correlation between perceived stress and occupational burnout. Multiple linear regression was conducted to identify influencing factors of occupational burnout. Results A total of 1388 valid questionnaires were collected, with an effective response rate of 90.96%. Among them, 437 nurses (57.0%), 273 physicians (58.6%), 24 pharmacists (57.1%), and 62 administrators (54.9%) reported positive perceived health risk stress (P=0.892). Additionally, 392 nurses (51.1%), 213 physicians (45.7%), 19 pharmacists (45.2%), and 53 administrators (46.9%) reported positive occupational burnout (P=0.005). Perceived stress was positively correlated with occupational burnout among nurses, physicians, pharmacists, and administrators (r=0.5973, 0.5687, 0.5464, and 0.5276, respectively; P＜0.01). The multiple linear regression identified perceived stress (b=1.4587, P＜0.001), job satisfaction (b=−7.4195, P＜0.001), self-rated health (b=−2.0428, P＜0.001), working years (b=−0.1135, P=0.016), and being a nurse (compared with an administrators) (b=3.2435, P=0.045) as significant factors for occupational burnout (P<0.001). Conclusion Perceived health risk stress and occupational burnout are common among hospital staff, with nurses experiencing significantly higher levels of occupational burnout compared to other positions. Hospital managers should pay more attention to staff with higher perceived stress, lower job satisfaction, poorer self-rated health, and shorter working years, particularly nurses.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old.The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old.The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old.The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old.The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

The magnitude of the problem of stunting is high in low- to middle-income countries, including Indonesia. The government of Indonesia has implemented specific and sensitive intervention programs to reduce this problem. This public health problem requires multidisciplinary management with suitable approaches and programs. In the first 1000 days of life, the quality of life is determined by conception and delivery until two years old.The requirement and fulfillment of nutrients during this period would benefit the growth and development of children. Indonesia is an archipelago country with 100,000 km of coastline and 16,771 islands with great potential for fishing. In coastal areas, optimizing protein consumption from the sea and enhancing educational programs in psychosocial care are appropriate intervention programs that will benefit stunting eradication. The complexity of the stunting problem puts authorities and other stakeholders together to formulate and design appropriate comprehensive intervention programs to improve the quality of life of the next generation.

Objective:To analyze the consistency between MT-9000 and IOLMaster 700 in measuring preoperative ocular biometric parameters in patients with age-related cataracts.Methods:A cross-sectional study was conducted.A total of 536 patients (536 eyes) were consecutively included and scheduled for cataract extraction combined with intraocular lens implantation at Aier Eye Hospital of Wuhan University from June 20 to August 22, 2024.Two visualized sweep-frequency biometers, MT-9000 and IOLMaster 700, were used to measure the biometric parameters of all the patients.The parameters including axial length (AL), white to white (WTW), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), and mean keratometry (Km). The AL detection rates of the two instruments were compared, as were the differences in above parameters, and the correlation and consistency of the measurements were analyzed.Patients were divided into three groups based on AL measured by MT-9000: a short axis group (AL<22 mm) comprising 27 eyes, a normal axis group (22≤AL≤25 mm) comprising 392 eyes, and a long axis group (AL>25 mm) comprising 104 eyes.The differences in measured AL in different subgroups were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Aier Eye Hospital, Wuhan University (No.2024IRB06017). Written informed consent was obtained from each subject.Results:The AL detection rate measured by MT-9000 was 99.3% (532/536), higher than 97.6% (523/536) measured by IOLMaster 700, with a statistically significant difference ( χ2=4.841, P=0.028). MT-9000 AL, LT and Km measurements were all higher than IOLMaster 700 measurements, showing statistically significant differences ( Z=6.418, t=4.971, 5.179; all P<0.001). WTW and CCT measurements from MT-9000 were both lower than those from IOLMaster 700, showing statistically significant differences ( Z=-3.017, t=16.322; both P<0.05). After grouping based on AL measurements from MT-9000, there was no statistically significant differences in AL measurements between MT-9000 and IOLMaster 700 in the short axis group and the normal axis group ( Z=-1.530, P=0.126; t=-0.880, P=0.380). In the long axis group, the AL measured by MT-9000 was longer than that by IOLMaster 700, with a statistically significant difference ( Z=7.254, P<0.001). The intra-class correlation coefficient values of AL, WTW, ACD, LT, CCT, and Km measured by MT-9000 and IOLMaster 700 were 1.000, 0.616, 0.997, 0.999, 0.988, and 0.995 (all P<0.001), respectively.The 95% limits of agreement (LoA) of AL, WTW, ACD, LT, CCT, and Km measured by Bland-Altman analysis were -0.06-+ 0.08 mm, -0.64-+ 0.57 mm, -0.06-+ 0.06 mm, -0.04-+ 0.05 mm, -13.6-+ 6.3 μm and -0.26-+ 0.32 D, respectively, which had 6.5%, 3.6%, 5.3%, 6.3%, 6.5% and 4.4% of the data points outside the 95% LoA. Conclusions:MT-9000 shows favorable agreement with IOLMaster 700 in the measurement of AL, ACD, LT, CCT and Km.MT-9000 is suitable for preoperative biometrics measurement in cataract patients.However, the agreement between the two devices is not desirable in the measurement of WTW, and interchangeable use of these two devices is not recommended in this regard.Additionally, MT-9000 outperforms IOLMaster 700 in terms of AL detection rate.

Objective:To analyze the effect of meridian scraping combined with thunder fire moxibustion in improving the motor function and hemorheology of patients with shoulder hand syndrome (SHS) after ischemic stroke, in order to provide reference for clinical intervention of SHS patients after ischemic stroke.Methods:A prospective study was conducted using a simple random sampling method to select SHS patients after ischemic stroke admitted to Shijiazhuang Hospital of Traditional Chinese Medicine from January 2020 to June 2023, and were randomly divided into two groups. The thunder-fire moxibustion group were given routine nursing and thunder-fire moxibustion therapy, and the combined group were additionally given scraping therapy along meridians on the basis of thunder-fire moxibustion group. The Upper Limb Fugl-Meyer Motor Function Assessment Scale (U-FMA) score, Visual Analogue Scale (VAS) score, Action Research Arm Test (ARAT) score, shoulder joint activity score, hemorheological indicators (hematocrit, plasma viscosity, platelet adhesion rate) and activities of daily living (Barthel Index), etc. were compared between two groups before and after intervention.Results:Finally, 86 patients with SHS after ischemic stroke were included, with 42 patients in the thunder-fire moxibustion group, including 25 males and 17 females, aged (59.37 ± 7.64) years; 44 patients in the combined group, including 24 males and 20 females, aged (59.52 ± 7.61) years. Before intervention, there was no statistical significance in U-FMA score, VAS score, ARAT score, shoulder joint activity score, hemorheology index level and Barthel Index between two groups (all P>0.05). After intervention, the U-FMA score, ARAT score and Barthel Index in the combined group were (48.21 ± 4.85), (40.22 ± 4.64), (56.43 ± 9.76) points, respectively, which were higher than (44.56 ± 4.23), (35.98 ± 4.37), (51.97 ± 8.31) points in the thunder-fire moxibustion group, the differences were statistically significant ( t =3.71, 4.36, 2.28, all P<0.05). The VAS score, shoulder joint mobility score, blood cell volume, plasma viscosity and platelet adhesion rate in the combined group were (2.44 ± 0.87) points, (1.23 ± 0.25) points, 0.44 ± 0.02, (1.35 ± 0.32) mPa·s, (53.56 ± 5.71)%, respectively, which were lower than (3.05 ± 0.99) points, (1.58 ± 0.22) points, 0.46 ± 0.02, (1.72 ± 0.36) mPa·s, (62.53 ± 5.94)% in the thunder-fire moxibustion group, the differences were statistically significant ( t values were 3.04-7.14, all P<0.05). Conclusions:Scraping along meridians combined with thunder-fire moxibustion therapy can achieve good intervention effect in patients with SHS after ischemic stroke, improve the upper limb motor function and hemorheology of patients, and enhance the activities of daily living.

Objective:To analyze the consistency between MT-9000 and IOLMaster 700 in measuring preoperative ocular biometric parameters in patients with age-related cataracts.Methods:A cross-sectional study was conducted.A total of 536 patients (536 eyes) were consecutively included and scheduled for cataract extraction combined with intraocular lens implantation at Aier Eye Hospital of Wuhan University from June 20 to August 22, 2024.Two visualized sweep-frequency biometers, MT-9000 and IOLMaster 700, were used to measure the biometric parameters of all the patients.The parameters including axial length (AL), white to white (WTW), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), and mean keratometry (Km). The AL detection rates of the two instruments were compared, as were the differences in above parameters, and the correlation and consistency of the measurements were analyzed.Patients were divided into three groups based on AL measured by MT-9000: a short axis group (AL<22 mm) comprising 27 eyes, a normal axis group (22≤AL≤25 mm) comprising 392 eyes, and a long axis group (AL>25 mm) comprising 104 eyes.The differences in measured AL in different subgroups were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Aier Eye Hospital, Wuhan University (No.2024IRB06017). Written informed consent was obtained from each subject.Results:The AL detection rate measured by MT-9000 was 99.3% (532/536), higher than 97.6% (523/536) measured by IOLMaster 700, with a statistically significant difference ( χ2=4.841, P=0.028). MT-9000 AL, LT and Km measurements were all higher than IOLMaster 700 measurements, showing statistically significant differences ( Z=6.418, t=4.971, 5.179; all P<0.001). WTW and CCT measurements from MT-9000 were both lower than those from IOLMaster 700, showing statistically significant differences ( Z=-3.017, t=16.322; both P<0.05). After grouping based on AL measurements from MT-9000, there was no statistically significant differences in AL measurements between MT-9000 and IOLMaster 700 in the short axis group and the normal axis group ( Z=-1.530, P=0.126; t=-0.880, P=0.380). In the long axis group, the AL measured by MT-9000 was longer than that by IOLMaster 700, with a statistically significant difference ( Z=7.254, P<0.001). The intra-class correlation coefficient values of AL, WTW, ACD, LT, CCT, and Km measured by MT-9000 and IOLMaster 700 were 1.000, 0.616, 0.997, 0.999, 0.988, and 0.995 (all P<0.001), respectively.The 95% limits of agreement (LoA) of AL, WTW, ACD, LT, CCT, and Km measured by Bland-Altman analysis were -0.06-+ 0.08 mm, -0.64-+ 0.57 mm, -0.06-+ 0.06 mm, -0.04-+ 0.05 mm, -13.6-+ 6.3 μm and -0.26-+ 0.32 D, respectively, which had 6.5%, 3.6%, 5.3%, 6.3%, 6.5% and 4.4% of the data points outside the 95% LoA. Conclusions:MT-9000 shows favorable agreement with IOLMaster 700 in the measurement of AL, ACD, LT, CCT and Km.MT-9000 is suitable for preoperative biometrics measurement in cataract patients.However, the agreement between the two devices is not desirable in the measurement of WTW, and interchangeable use of these two devices is not recommended in this regard.Additionally, MT-9000 outperforms IOLMaster 700 in terms of AL detection rate.