The National Institute for Health and Care Excellence(NICE)first updated its 2013 Health Technology Evaluations Guidelines in 2022,followed by further minor adjustments in 2023.This round of updates primarily focuses on five key areas:mea-suring the value of health technologies,understanding and improving the evidence base,structured decision-making,addressing challenging diseases and technologies,and ensuring consistency in methods across evaluation and review projects.It outlines the up-date process and major changes,providing an analysis of these key points with the aim of offering valuable insights and methodologi-cal references for health technology assessment in China.

The Keap1-Nrf2 pathway has been shown to be an important defense mechanism against oxidative stress, which may be an effective therapeutic strategy for many diseases. The research progresses on Keap1-Nrf2 pathway in inflammatory diseases were mainly reviewed. The basic components and activation mechanism of Keap1-Nrf2 pathway were introduced. The relationship between Keap1-Nrf2 pathway and the crosstalk between NF-κB pathway and HO-1 pathway, the expression of inflammatory mediators and enzymes, and inflammatory bodies were expounded. Natural product-derived inhibitors, small molecule inhibitors targeting Keap1-Nrf2 pathway and their clinical progress were introduced, and the potential application value of Keap1-Nrf2 pathway in the treatment of inflammation was discussed.

Objective:To explore the clinical effect on the treatment of radiation induced deep ulcers in the inguinal region with ipsilateral anterolateral thigh chimeric perforator flap.Methods:From March 2020 to March 2024, retrospective analysis of 8 patients with radiation induced deep ulcers in the inguinal region were treated with ipsilateral anterolateral thigh chimeric perforator flap in the Medical Centre of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University. All ulcers induced by radiation were caused by postoperative radiotherapy in the inguinal region, of which 4 were of vulvar or penile cancer, 2 of urinary tract tumour, 1 of inguinal protuberant dermatofibrosarcoma and 1 of myofibroblastic sarcoma in lower abdominal wall. The course of the radiation induced ulcer was 0.5-11.0 years, with an average of 2.9 years. The sizes of the ulcerative wound were 2.5 cm × 3.0 cm - 5.5 cm × 7.5 cm. Preoperative biopsies of the tissues around wound and pelvic CT scans were performed to preliminarily exclude a tumour recurrence or an ulcerative malignancy, as well as to confirm the depth of radiation ulcer. The wound size after debridement was 4.5 cm × 6.0 cm-13.5 cm × 19.0 cm, with a depth of 2.0-4.0 cm. An ipsilateral anterolateral thigh chimeric perforator flap was transferred to reconstruct the wound, after the wound edges were cleared from tumour through intraoperative frozen section examinations. The flaps were 5.5 cm × 7.0 cm - 14.0 cm × 20.0 cm in size, with the volumes of muscle flap at 7.0 cm × 4.0 cm × 3.0 cm - 14.0 cm × 7.0 cm × 3.0 cm. After having the deep defect at the base of wound filled with a muscle flap, the wound surface was covered by the flap. Four patients had direct suture of the donor sites and 4 received a thick skin graft of head or contralateral thigh grafting. Survival of the anterolateral thigh chimeric perforator flaps and the healing of donor sites were observed after surgery through scheduled postoperative follow-up by the visits of outpatient clinic and distant interviews via telephone, WeChat or the internet hospital.Results:One of the ipsilateral anterolateral thigh chimeric perforator flaps had venous occlusion within 24 hours after surgery. Emergency surgical exploration revealed that it was caused by a haematoma compression due to haemorrhage in the muscle flap. Further debridement, haemostasis and suture were performed, then the wound healed. The rest of 7 flaps all survived. All donor sites healed primarily. The postoperative follow-up lasted for 5-17 months with all of the 8 patients, at 8.4 months in average. Both the donor and recipient sites healed well without recurrence of radiation ulcer in the affected sites. The appearance and texture of the flaps were good, and there was no obvious functional impairment at the donor sites.Conclusion:The treatment of radiation induced deep ulcer in the inguinal region with an ipsilateral anterolateral thigh chimeric perforator flap has shown good results, without recurrence of ulcer after surgery. The appearance and texture of the affected sites are good, and there is no secondary functional impairment at the donor site.

Objective:To analyze the causal relationship between type 2 diabetes and lumbar bone mineral density and spinal fractures and to further explore the impact of central obesity on the diabetic bone paradox.Methods:A Mendelian randomization (MR) study was implemented. Single nucleotide polymorphisms (SNPs) associated with type 2 diabetes were selected from the data of genome-wide association studies as instrumental variables, with lumbar bone density and spinal fractures as the outcome variables. The inverse variance weighting method, weighted median method, and MR-Egger regression were applied to identify a causal relationship between type 2 diabetes and osteoporosis at the genetic level. Additionally, to analyze the impact of central obesity in the diabetic bone paradox, the waist-to-hip ratio was introduced as a new exposure variable, with type 2 diabetes and lumbar bone density as outcome variables, and the MR method was applied again to uncover the influencing factors.Results:The screening criteria were based on the three main assumptions of MR. Finally, 62 SNPs for type 2 diabetes and 241 SNPs for waist-to-hip ratio were included in the MR analysis. Using inverse variance weighting as the primary analysis, the causal association effect analysis indicated a causal relationship between type 2 diabetes and increased lumbar bone density ( OR=1.047 6, P=0.007) and spinal fractures ( OR=1.000 9, P=0.014). A causal relationship between waist-to-hip ratio and type 2 diabetes ( OR=1.638 6, P<0.001) was identified, indicating that the waist-to-hip ratio was a risk factor for type 2 diabetes and may have a causal association with increased lumbar bone density ( OR=1.096 3, P=0.044). This suggests that the waist-to-hip ratio may indirectly affect the relationship between diabetes and osteoporosis. The MR-Egger intercept test showed no horizontal pleiotropy in this study. The leave-one-out analysis indicated that no single SNP had a significant impact on the overall results. Furthermore, the MR-pleiotropy residual sum and outlier (MR-PRESSO) test results did not detect any outlier SNPs. Conclusion:MR analysis identified a causal relationship between type 2 diabetes and increased lumbar bone density as well as a higher risk of spinal fractures, a paradox that may be related to central obesity.

Objective:To explore the clinical effect on the treatment of radiation induced deep ulcers in the inguinal region with ipsilateral anterolateral thigh chimeric perforator flap.Methods:From March 2020 to March 2024, retrospective analysis of 8 patients with radiation induced deep ulcers in the inguinal region were treated with ipsilateral anterolateral thigh chimeric perforator flap in the Medical Centre of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University. All ulcers induced by radiation were caused by postoperative radiotherapy in the inguinal region, of which 4 were of vulvar or penile cancer, 2 of urinary tract tumour, 1 of inguinal protuberant dermatofibrosarcoma and 1 of myofibroblastic sarcoma in lower abdominal wall. The course of the radiation induced ulcer was 0.5-11.0 years, with an average of 2.9 years. The sizes of the ulcerative wound were 2.5 cm × 3.0 cm - 5.5 cm × 7.5 cm. Preoperative biopsies of the tissues around wound and pelvic CT scans were performed to preliminarily exclude a tumour recurrence or an ulcerative malignancy, as well as to confirm the depth of radiation ulcer. The wound size after debridement was 4.5 cm × 6.0 cm-13.5 cm × 19.0 cm, with a depth of 2.0-4.0 cm. An ipsilateral anterolateral thigh chimeric perforator flap was transferred to reconstruct the wound, after the wound edges were cleared from tumour through intraoperative frozen section examinations. The flaps were 5.5 cm × 7.0 cm - 14.0 cm × 20.0 cm in size, with the volumes of muscle flap at 7.0 cm × 4.0 cm × 3.0 cm - 14.0 cm × 7.0 cm × 3.0 cm. After having the deep defect at the base of wound filled with a muscle flap, the wound surface was covered by the flap. Four patients had direct suture of the donor sites and 4 received a thick skin graft of head or contralateral thigh grafting. Survival of the anterolateral thigh chimeric perforator flaps and the healing of donor sites were observed after surgery through scheduled postoperative follow-up by the visits of outpatient clinic and distant interviews via telephone, WeChat or the internet hospital.Results:One of the ipsilateral anterolateral thigh chimeric perforator flaps had venous occlusion within 24 hours after surgery. Emergency surgical exploration revealed that it was caused by a haematoma compression due to haemorrhage in the muscle flap. Further debridement, haemostasis and suture were performed, then the wound healed. The rest of 7 flaps all survived. All donor sites healed primarily. The postoperative follow-up lasted for 5-17 months with all of the 8 patients, at 8.4 months in average. Both the donor and recipient sites healed well without recurrence of radiation ulcer in the affected sites. The appearance and texture of the flaps were good, and there was no obvious functional impairment at the donor sites.Conclusion:The treatment of radiation induced deep ulcer in the inguinal region with an ipsilateral anterolateral thigh chimeric perforator flap has shown good results, without recurrence of ulcer after surgery. The appearance and texture of the affected sites are good, and there is no secondary functional impairment at the donor site.

Objective:To analyze the causal relationship between type 2 diabetes and lumbar bone mineral density and spinal fractures and to further explore the impact of central obesity on the diabetic bone paradox.Methods:A Mendelian randomization (MR) study was implemented. Single nucleotide polymorphisms (SNPs) associated with type 2 diabetes were selected from the data of genome-wide association studies as instrumental variables, with lumbar bone density and spinal fractures as the outcome variables. The inverse variance weighting method, weighted median method, and MR-Egger regression were applied to identify a causal relationship between type 2 diabetes and osteoporosis at the genetic level. Additionally, to analyze the impact of central obesity in the diabetic bone paradox, the waist-to-hip ratio was introduced as a new exposure variable, with type 2 diabetes and lumbar bone density as outcome variables, and the MR method was applied again to uncover the influencing factors.Results:The screening criteria were based on the three main assumptions of MR. Finally, 62 SNPs for type 2 diabetes and 241 SNPs for waist-to-hip ratio were included in the MR analysis. Using inverse variance weighting as the primary analysis, the causal association effect analysis indicated a causal relationship between type 2 diabetes and increased lumbar bone density ( OR=1.047 6, P=0.007) and spinal fractures ( OR=1.000 9, P=0.014). A causal relationship between waist-to-hip ratio and type 2 diabetes ( OR=1.638 6, P<0.001) was identified, indicating that the waist-to-hip ratio was a risk factor for type 2 diabetes and may have a causal association with increased lumbar bone density ( OR=1.096 3, P=0.044). This suggests that the waist-to-hip ratio may indirectly affect the relationship between diabetes and osteoporosis. The MR-Egger intercept test showed no horizontal pleiotropy in this study. The leave-one-out analysis indicated that no single SNP had a significant impact on the overall results. Furthermore, the MR-pleiotropy residual sum and outlier (MR-PRESSO) test results did not detect any outlier SNPs. Conclusion:MR analysis identified a causal relationship between type 2 diabetes and increased lumbar bone density as well as a higher risk of spinal fractures, a paradox that may be related to central obesity.

The National Institute for Health and Care Excellence(NICE)first updated its 2013 Health Technology Evaluations Guidelines in 2022,followed by further minor adjustments in 2023.This round of updates primarily focuses on five key areas:mea-suring the value of health technologies,understanding and improving the evidence base,structured decision-making,addressing challenging diseases and technologies,and ensuring consistency in methods across evaluation and review projects.It outlines the up-date process and major changes,providing an analysis of these key points with the aim of offering valuable insights and methodologi-cal references for health technology assessment in China.

Standardized residency training is one of the important contents of modern clinical doctor training and it is ex-tremely important for improving the quality of clinician and medical treatment.Mentors play an important role in the standardized residency training programs,who guaranteed qualified and homogeneous training for the residents.Double-mentor system had been carried out in standardized residency programs of the First People's Hospital of Kunshan city,which appeared to be valuable assets for improving the comprehensive quality and professional level of residential training guidance and resident trainees,so as to help medical students transform from students to qualified and excellent clinical physicians after graduation.Double-mentor sys-tem can also improve the tutor's own teaching ability and the efficiency of training,it is valuable for improving the level of clini-cal medicine,expanding the teaching staff of dual tutors and the teaching quality of comprehensive hospitals,which has a two-way strategy of mutual learning between teaching and learning.However,this system still needs improvement,and there are some lim-itations that need further exploration.For examples,the selection criteria for mentors needs to be formulated and reviewed more reasonably,responsibility and quality control of mentors are not perfect,the guidance and quality control of resident trainees need to be strengthened,and standardized evaluation system needs to be established.

Objective:To investigate the relationship between body mass index (BMI) and gestational hypertension using two-sample Mendelian randomization analysis.Methods:The summary level data for BMI and gestational hypertension were obtained from the genome-wide association study (the deadline for data inclusion was October 31, 2023). All data were analyzed by inverse variance weighting, MR-Egger regression, weighted median, simple model and weighted model methods. Cochrane Q test was used to evaluate heterogeneity, MR-Egger regression intercept test and funnel plot were used to assess horizontal pleiotropy. Results:Inverse variance weighting result under fixed effects and random effects models showed that the risk of gestational hypertension increased with the increase of BMI ( OR = 1.62 and 1.62, 95% CI 1.39 to 1.88 and 1.39 to 1.88, P<0.01). Sensitivity analysis results including MR-Egger regression, weighted median and weighted model methods showed that BMI increased the risk of gestational hypertension ( OR = 1.51, 1.56 and 1.71; 95% CI 1.01 to 2.26, 1.23 to 1.99 and 1.09 to 2.69; P<0.05 or <0.01). Although Cochrane Q test result showed evidence of heterogeneity ( P = 0.04), inverse variance weighting under a random model suggested that BMI increased the risk of gestational hypertension. Horizontal pleiotropy was not observed in the above analysis ( P = 0.73). Conclusions:Obesity may increase the risk of gestational hypertension. Pregnant women should pay attention to weight control to decrease the risk of gestational hypertension.

Health technology assessment(HTA)is an important tool to inform health decision-making.Although highly related to ethical issues in the context of HTA,equity has attracted much attention from the academia,a consensus has not yet been reached on how to define and evaluate equity in China and abroad.It introduces the concept of equity,pointes out the necessity to realize health equity and the reflection of equity in healthcare sector,and further elaborates four ways to consider equity,and described the official practice of equity in HTA at home and abroad.It proposes several suggestions for China's HTA:considering equity in HTA and the discussion of equity should depend on specific decision-making scenarios;clarifying what health measurement perspective should be adopted before measuring health equity;paying attention to the value judgment of equity adopted by various stakeholders;conducting basic researches on the general population's preference for health measurement perspectives and value judgments of equity in China in a gesture to improve the evaluation system of equity in HTA.