OBJECTIVE To evaluate the long-term cost-effectiveness of insulin degludec and insulin aspart （IDegAsp） in patients with type 2 diabetes mellitus （T2DM） in China. METHODS A cost-effectiveness analysis was conducted from the perspective of the Chinese healthcare system， using the CORE diabetes model to simulate long-term （20-year） health and economic outcomes. Baseline cohort characteristics and treatment effect data were derived from the CREATE study. The prices of glucose- lowering drugs were obtained from medical insurance payment standards and the average winning bid prices in the follow-up round of the specialized centralized procurement for insulin， while the daily dosages were derived from the CREATE study. The costs of complications and utility values were obtained from published literature， with a discount rate of 5%. One-way sensitivity analysis， scenario analysis， and probabilistic sensitivity analysis were performed to verify the robustness of the results. RESULTS Patients switching from previous once-daily basal insulin regimens to IDegAsp therapy gained an incremental 0.190 quality-adjusted life year （QALY） with direct medical cost savings of 42 163.58 yuan. For those switching from premixed insulin therapies， IDegAsp treatment provided 0.130 incremental QALY and reduced direct healthcare costs by 41 129.11 yuan. The outcome was significantly influenced by the discount rate and the cost of complications. Probabilistic sensitivity analysis and scenario analysis confirmed the robustness of these findings. CONCLUSIONS Switching from previous daily basal insulin or premixed insulin regimens to IDegAsp in Chinese patients with T2DM can improve patients’ long-term health outcomes and achieve cost savings， making it a more cost-effective treatment option.

OBJECTIVE From the perspective of China’s healthcare system， to evaluate the cost-effectiveness of amivantamab combined with chemotherapy versus chemotherapy alone for patients with EGFR-mutated advanced non-small cell lung cancer （NSCLC） who experience disease progression during or after treatment with osimertinib monotherapy. METHODS The Markov model was established according to MARIPOSA-2 clinical trial. The simulation time limit was 10 years and the cycle period lasted for 21 days. The incremental cost-effectiveness ratio（ICER） of amivantamab combined with chemotherapy versus chemotherapy alone for the treatment of EGFR-mutated advanced NSCLC was calculated， and then compared with the willingness-to-pay（WTP） threshold set in this study[3 times the per capita gross domestic product（GDP） of China in 2023， which was 268 200 yuan per quality-adjusted life year（QALY）]， in order to assess its cost-effectiveness. Single-factor sensitivity analysis and probability sensitivity analysis were performed to evaluate the stability of the model； scenario analysis was carried out to determine the potential price of amivantamab at which the regimen became cost-effective. RESULTS Compared with chemotherapy alone， the cost of amivantamab combined with chemotherapy was higher （1 248 411.60 yuan vs. 89 023.39 yuan）， but at the same time， there were also more benefits of survival （0.756 QALY vs. 0.584 QALY）， ICER was 6 757 285.38 yuan/QALY. ICER was most affected by the utility of progression-free survival and the price of amivantamab. The price of amivantamab decreased to 310.3 yuan per 350 mg， and the combination therapy became cost-effective， compared with chemotherapy alone. CONCLUSIONS From the perspective of Chinese health system， when the WTP threshold is set at three times the per capita GDP of the Chinese population in 2023， amivantamab combined with chemotherapy is not cost-effective for EGFR-mutated advanced NSCLC； the patients’ affordability can be improved when the price of amivantamab experiences a significant decrease.

OBJECTIVE To systematically evaluate the efficacy and safety of Insulin degludec and liraglutide injection （IDegLira） and Insulin glargine and lixisenatide injection（iGlarLixi） in the treatment of type 2 diabetes mellitus（T2DM）， and provide an evidence-based basis for the clinical treatment of T2DM. METHODS Computerized searches of PubMed， Embase， the Cochrane Library， CNKI， Wanfang data and VIP were conducted with a time frame from the inception to August 2024. Randomized controlled trials（RCTs） were rigorously screened according to inclusion and exclusion criteria， from which information was extracted and included studies were evaluated for risk of bias. Network meta-analysis was performed using Stata 14.0 software. RESULTS A total of 15 RCTs， including 9 513 patients， were included， involving four treatment regimens： IDegLira， iGlarLixi， insulin degludec（IDeg）， and insulin glargine（iGlar）. The differences between IDegLira and iGlarLixi were not statistically significant（P＞0.05） for the outcome indexes of glycosylated hemoglobin（HbA1c）， fasting blood glucose， body weight， and the incidence of adverse events（P＞0.05）； for the outcome index of the incidence of hypoglycemic events， IDegLira was significantly superior to iGlarLixi [OR＝0.41，95%CI（0.18，0.91），P＜0.05]. Surface under the cumulative ranking curve（SUCRA） results showed that iGlarLixi（84.5%）＞IDegLira（81.7%） in lowering HbA1c； IDegLira（71.3%）＞iGlarLixi（20.0%） in lowering fasting blood glucose； IDegLira（90.7%）＞iGlarLixi（61.8%） in lowering body weight； IDegLira（95.5%）＞iGlarLixi（9.7%） in reducing the incidence of hypoglycemic events； and IDegLira（27.1%）＞iGlarLixi（14.5%） in reducing the incidence of adverse events. CONCLUSIONS iGlarLixi has better therapeutic efficacy in reducing HbA1c； IDegLira has better therapeutic efficacy in reducing fasting blood glucose and body weight. IDegLira has the lowest risk of hypoglycemia.

Objective:To investigate the feasibility and effectiveness of 3D ultrasound technique in diagnosing uterine arteriovenous fistula(UAVF),and compare it with two-dimensional color Doppler ultrasound(2D-CDUS).Methods:A total of fifty patients with suspected uterine arteriovenous fistula(UAVF)who received examination in the Department of Ultrasound,Baoding Maternal and Child Health Care Hospital from November 2023 to September 2024 were selected,and they were divided into control group and observation group by the random number table method,with 25 cases in each group.The control group received 2D-CDUS examination,while the observation group received the examination of three-dimensional transvaginal ultrasound(3D-TVS).The results of the ultrasound examinations were recorded,and the diagnostic indicators of the ultrasound examinations were calculated.The result of contrast enhanced ultrasound(CEUS)to conduct comparison and analysis,and the receiver operating characteristic(ROC)curve was adopted to analyze the diagnostic value of the two kinds of diagnostic methods.Results:There were no statistically significant differences in the positive rate and UAVF type after 2D-CDUS,3D-TVS and CEUS examinations between control group and observation group(P>0.05).There were no statistically significant difference in the sensitivity,specificity,accuracy and positive predictive value between the control group with 2D-CDUS examination and the observation group with 3D-TVS examination(P>0.05).The negative predictive value of 3D-TVS was 83.33%,which was higher than that of 2D-CDUS,and the difference was statistically significant(x2=7.481,P<0.05).Conclusion:The 3D-TVS technique shows a favorably negative predictive value in diagnosing UAVF,which can effectively make up for deficiencies of 2D-CDUS.It has the feasibility and effectiveness of clinical diagnosis,and provides a more comprehensive assessment method for early diagnosis for UAVF.

Objective:To explore the application value of three-dimensional ultrasound(3D-US)combined with two-dimensional trans vaginal sonography(2D-TVS)in diagnosing uterine arteriovenous fistula(UAVF).Methods:A total of 36 patients with suspected UAVF who admitted to Baoding Maternal and Child Health Care Hospital from January 2024 to December 2024 were retrospective selected.All of them underwent 3D-US,2D-TVS and combined examinations of 3D-US and 2D-TVS.The gynecological intravenous contrast-enhanced ultrasound was used as the"gold standard"to compare and analyze the sensitivity,specificity,accuracy rate,positive predictive value and negative predictive value of 3D-US,2D-TVS and the combined examination of them.The diagnostic efficacies of the three diagnostic methods were calculated by the four-grid table method and the analysis of the receiver operating characteristic(ROC)curve.The detection rates of 2D-TVS and combined examination of 2D-TVS and 3D-US for UAVF imaging signs were compared.Results:In 36 patients,gold standard confirmed 26 positive cases and 10 negative cases.The sensitivity,specificity,accuracy rate,positive predictive value and negative predictive value of 2D-TVS examination were respectively 69.23%,80.00%,72.22%,90.00%and 50.00%.These indicators of 3D-US examinations were respectively 84.62%,90.00%,86.11%,95.65%and 69.23%.These indicators of the combined examination were respectively 92.31%,90.00%,91.67%,96.00%and 81.82%.There were not statistically significant differences in these indicators among the three diagnostic methods(P>0.05).However,the sensitivity,accuracy rate of the combined examination were respectively higher than those of 2D-TVS examination,and the differences were statistically significant(x2=4.457,4.600,P<0.05).The detection rates of the sings included lake-like,multicolored Mosaic and blood flow spectrum of high-speed low-resistance in UAVF images of the combined examination were all higher than those of 2D-TVS examination,and the differences were statistically significant(x2=4.000,4.431,4.600,P<0.05).Conclusion:The combination of 3D-US and 2D-TVS can significantly improve the diagnostic sensitivity,accuracy and detection rate of imaging signs in the diagnosis for UAVF,which has important clinical application value.

In order to integrate clinical data, image data, and omics data scattered across different systems, and effectively support clinical research based on real-world data, a hospital has integrated Hadoop big data processing technology with distributed parallel database technology to build a data storage and calculation system that integrates lakes and warehouses. Through the integration of 15 medical information system data, data governance based on patient master indexes, and the design and development of an application platform that covered 8 major functions and integrated general scientific research and specialized disease applications, the hospital has built an integrated scientific research big data platform, which included 3.3 billion pieces of data from 20.26 million patients and 98.57 million visits, and has built 3 specialized disease databases. From January to August 2024, it has supported data extraction and analysis for 35 research projects, reducing traditional code-based data retrieval time from 5-45 workdays to several hours or even minutes, significantly enhancing the efficiency of clinical research.

Medical artificial intelligence （AI） is a new type of application formed by the combination of machine learning， computer vision， natural language processing， and other technologies with clinical medical treatment. With the continuous iteration and development of relevant technologies， medical AI has shown great potential in improving the efficiency of diagnosis and treatment， and service quality， but it also increases the possibility of triggering ethical issues. Ethical issues resulting from the clinical application of medical AI were analyzed， including the lack of algorithmic interpretability and transparency of medical AI， leading to information asymmetry and cognitive discrepancies； the concerning status of security and privacy protection of medical data； and the complex and unclear division of responsibilities due to the collaborative participation of multiple subjects in the clinical application of medical AI， resulting in increased difficulty in the identification of medical accidents and clarification of responsibilities. The paper proposed the principles of not harming patients’ interests， physician’s subjectivity， fairness and inclusiveness， and rapid response. It also explored the strategies and implementation paths for responding to the ethical issues of medical AI from multiple perspectives， including standardizing the environment and processes， clarifying responsibility attribution， continuously assessing the impact of data protection， guaranteeing data security， ensuring model transparency and interpretability， carrying out multi-subject collaboration， as well as the principles of being driven by ethical values and adhering to the “human health-centeredness.” It aimed to provide guidance for the healthy development of medical AI， ensuring technological progress while effectively managing and mitigating accompanying ethical risks， thereby promoting the benign development of medical AI technology and better serving the healthcare industry and patients.

Objective:To explore the application value of three-dimensional ultrasound(3D-US)combined with two-dimensional trans vaginal sonography(2D-TVS)in diagnosing uterine arteriovenous fistula(UAVF).Methods:A total of 36 patients with suspected UAVF who admitted to Baoding Maternal and Child Health Care Hospital from January 2024 to December 2024 were retrospective selected.All of them underwent 3D-US,2D-TVS and combined examinations of 3D-US and 2D-TVS.The gynecological intravenous contrast-enhanced ultrasound was used as the"gold standard"to compare and analyze the sensitivity,specificity,accuracy rate,positive predictive value and negative predictive value of 3D-US,2D-TVS and the combined examination of them.The diagnostic efficacies of the three diagnostic methods were calculated by the four-grid table method and the analysis of the receiver operating characteristic(ROC)curve.The detection rates of 2D-TVS and combined examination of 2D-TVS and 3D-US for UAVF imaging signs were compared.Results:In 36 patients,gold standard confirmed 26 positive cases and 10 negative cases.The sensitivity,specificity,accuracy rate,positive predictive value and negative predictive value of 2D-TVS examination were respectively 69.23%,80.00%,72.22%,90.00%and 50.00%.These indicators of 3D-US examinations were respectively 84.62%,90.00%,86.11%,95.65%and 69.23%.These indicators of the combined examination were respectively 92.31%,90.00%,91.67%,96.00%and 81.82%.There were not statistically significant differences in these indicators among the three diagnostic methods(P>0.05).However,the sensitivity,accuracy rate of the combined examination were respectively higher than those of 2D-TVS examination,and the differences were statistically significant(x2=4.457,4.600,P<0.05).The detection rates of the sings included lake-like,multicolored Mosaic and blood flow spectrum of high-speed low-resistance in UAVF images of the combined examination were all higher than those of 2D-TVS examination,and the differences were statistically significant(x2=4.000,4.431,4.600,P<0.05).Conclusion:The combination of 3D-US and 2D-TVS can significantly improve the diagnostic sensitivity,accuracy and detection rate of imaging signs in the diagnosis for UAVF,which has important clinical application value.

Objective:To investigate the feasibility and effectiveness of 3D ultrasound technique in diagnosing uterine arteriovenous fistula(UAVF),and compare it with two-dimensional color Doppler ultrasound(2D-CDUS).Methods:A total of fifty patients with suspected uterine arteriovenous fistula(UAVF)who received examination in the Department of Ultrasound,Baoding Maternal and Child Health Care Hospital from November 2023 to September 2024 were selected,and they were divided into control group and observation group by the random number table method,with 25 cases in each group.The control group received 2D-CDUS examination,while the observation group received the examination of three-dimensional transvaginal ultrasound(3D-TVS).The results of the ultrasound examinations were recorded,and the diagnostic indicators of the ultrasound examinations were calculated.The result of contrast enhanced ultrasound(CEUS)to conduct comparison and analysis,and the receiver operating characteristic(ROC)curve was adopted to analyze the diagnostic value of the two kinds of diagnostic methods.Results:There were no statistically significant differences in the positive rate and UAVF type after 2D-CDUS,3D-TVS and CEUS examinations between control group and observation group(P>0.05).There were no statistically significant difference in the sensitivity,specificity,accuracy and positive predictive value between the control group with 2D-CDUS examination and the observation group with 3D-TVS examination(P>0.05).The negative predictive value of 3D-TVS was 83.33%,which was higher than that of 2D-CDUS,and the difference was statistically significant(x2=7.481,P<0.05).Conclusion:The 3D-TVS technique shows a favorably negative predictive value in diagnosing UAVF,which can effectively make up for deficiencies of 2D-CDUS.It has the feasibility and effectiveness of clinical diagnosis,and provides a more comprehensive assessment method for early diagnosis for UAVF.

In order to integrate clinical data, image data, and omics data scattered across different systems, and effectively support clinical research based on real-world data, a hospital has integrated Hadoop big data processing technology with distributed parallel database technology to build a data storage and calculation system that integrates lakes and warehouses. Through the integration of 15 medical information system data, data governance based on patient master indexes, and the design and development of an application platform that covered 8 major functions and integrated general scientific research and specialized disease applications, the hospital has built an integrated scientific research big data platform, which included 3.3 billion pieces of data from 20.26 million patients and 98.57 million visits, and has built 3 specialized disease databases. From January to August 2024, it has supported data extraction and analysis for 35 research projects, reducing traditional code-based data retrieval time from 5-45 workdays to several hours or even minutes, significantly enhancing the efficiency of clinical research.