Objective:To explore the correlation between bile acid profiles and early efficacy of biologics for Crohn's disease (CD) .Methods:Patients with active CD who were treated with induction therapy with biologics (ustekinumab, vedolizumab, or combination therapy) in outpatient and inpatient clinics from January 2021 to March 2024 in Jinhua Central Hospital were included. Clinical data and serum bile acid profile of patients before treatment were collected. At the end of induction therapy, CD patients were categorized into remission and non-remission groups based on the CD activity index (CDAI) scores. Compare the clinical data of the two groups of patients with CD before induction treatment with biological agents, retrospective analysis of bile acid profiles in relation to early efficacy of biologics.Results:A total of 100 patients with CD were included, including 74 patients in remission group and 26 patients in non-remission group. Univariate analysis showed that hemoglobin [137 (119, 147) g/L vs. 121 (109, 136) g/L, P = 0.027], erythrocyte pressure volume [ (0.40 ± 0.06) % vs. (0.38 ± 0.05) %, P = 0.030], total bile acids[3.8 (2.4, 6.1) μmol/L比2.0 (1.5, 2.7) μmol/L, P < 0.001], cholic acid [0.188 (0.059, 0.597) μmol/L vs. 0.055 (0.024, 0.111) μmol/L, P < 0.001], chenodeoxycholic acid [0.812 (0.268, 1.717) μmol/L vs. 0.308 (0.087, 0.552) μmol/L, P < 0.001], and deoxycholic acid [0.042 (0.001, 0.299) μmol/L vs. 0.002 (0.001, 0.159) μmol/L, P = 0.028] were signficantly higher in remission group than those in unremission group. In addition, the pretreatment endoscopic score (SES-CD) [4.0 (0, 6.0) vs. 6.0 (3.0, 10.5), P = 0.025], erythrocyte sedimentation rate (ESR) [9.0 (2.8, 20.0) mm/1 h vs. 28.0 (12.8, 40.8) mm/1 h, P < 0.001] and C reactive protein (CRP) [0.6 (0.2, 6.7) mg/L vs. 9.1 (1.5, 23.9) mg/L, P < 0.001] in the remission group were lower than those in the non-remission group. Multirariate logistic regression analysis showed that chenodeoxycholic acid ( OR = 3.317, 95% CI: 1.270-12.437; P = 0.041) and ESR ( OR =0.979, 95% CI: 0.957-0.997; P = 0.034) were the independent influencing affecting the efficacy of biologics for the treatment of Crohn's disease in early stage. Conclusion:Chenodeoxycholic acid is an independent influencing factor of early efficacy of biologics for Crohn's disease.

Objective:To establish a monitoring and evaluation index system for the building project of national children′s regional medical centre (shorted as the evaluation system), so as to provide quantitative supports for output hospitals to fulfil their primary responsibilities and offer guidance for project hospitals to implement target management.Methods:From April to June 2024, through searching literature and policy document, and combining with the actual situation of national regional medical center construction, the initial indicators of the evaluation system were screened. An evaluation system were constructed using two rounds of Delphi method, and the weights of indicators were determined by analytic hierarchy process.Results:This study invited 17 experts. The participation rates of experts in the two rounds of consultation exceeded 90.00%, with an expert authority coefficient of 0.96. The final evaluation system comprised 2 primary indicators, 8 secondary indicators, and 52 tertiary indicators. The primary indicators included project implementation status and project outcomes, with relative weights of 44.44% and 55.56% respectively. Project implementation status included 4 secondary indicators: project organisation, resource allocation, project progress, and safeguard mechanisms. Project outcomes encompassed 4 secondary indicators: healthcare service capacity, regional talent development outreach, and collaborative innovation.Conclusions:The evaluation system established in this study demonstrated a high degree of scientificity and feasibility. It could effectively supported the process management and outcome evaluation of establishing the national children′s regional medical centre. This system provided a scientific basis for enhancing the quality and efficiency of children′s healthcare services, optimising policy formulation and resource allocation.

Objective:To explore the correlation between bile acid profiles and early efficacy of biologics for Crohn's disease (CD) .Methods:Patients with active CD who were treated with induction therapy with biologics (ustekinumab, vedolizumab, or combination therapy) in outpatient and inpatient clinics from January 2021 to March 2024 in Jinhua Central Hospital were included. Clinical data and serum bile acid profile of patients before treatment were collected. At the end of induction therapy, CD patients were categorized into remission and non-remission groups based on the CD activity index (CDAI) scores. Compare the clinical data of the two groups of patients with CD before induction treatment with biological agents, retrospective analysis of bile acid profiles in relation to early efficacy of biologics.Results:A total of 100 patients with CD were included, including 74 patients in remission group and 26 patients in non-remission group. Univariate analysis showed that hemoglobin [137 (119, 147) g/L vs. 121 (109, 136) g/L, P = 0.027], erythrocyte pressure volume [ (0.40 ± 0.06) % vs. (0.38 ± 0.05) %, P = 0.030], total bile acids[3.8 (2.4, 6.1) μmol/L比2.0 (1.5, 2.7) μmol/L, P < 0.001], cholic acid [0.188 (0.059, 0.597) μmol/L vs. 0.055 (0.024, 0.111) μmol/L, P < 0.001], chenodeoxycholic acid [0.812 (0.268, 1.717) μmol/L vs. 0.308 (0.087, 0.552) μmol/L, P < 0.001], and deoxycholic acid [0.042 (0.001, 0.299) μmol/L vs. 0.002 (0.001, 0.159) μmol/L, P = 0.028] were signficantly higher in remission group than those in unremission group. In addition, the pretreatment endoscopic score (SES-CD) [4.0 (0, 6.0) vs. 6.0 (3.0, 10.5), P = 0.025], erythrocyte sedimentation rate (ESR) [9.0 (2.8, 20.0) mm/1 h vs. 28.0 (12.8, 40.8) mm/1 h, P < 0.001] and C reactive protein (CRP) [0.6 (0.2, 6.7) mg/L vs. 9.1 (1.5, 23.9) mg/L, P < 0.001] in the remission group were lower than those in the non-remission group. Multirariate logistic regression analysis showed that chenodeoxycholic acid ( OR = 3.317, 95% CI: 1.270-12.437; P = 0.041) and ESR ( OR =0.979, 95% CI: 0.957-0.997; P = 0.034) were the independent influencing affecting the efficacy of biologics for the treatment of Crohn's disease in early stage. Conclusion:Chenodeoxycholic acid is an independent influencing factor of early efficacy of biologics for Crohn's disease.

Objective:To establish a monitoring and evaluation index system for the building project of national children′s regional medical centre (shorted as the evaluation system), so as to provide quantitative supports for output hospitals to fulfil their primary responsibilities and offer guidance for project hospitals to implement target management.Methods:From April to June 2024, through searching literature and policy document, and combining with the actual situation of national regional medical center construction, the initial indicators of the evaluation system were screened. An evaluation system were constructed using two rounds of Delphi method, and the weights of indicators were determined by analytic hierarchy process.Results:This study invited 17 experts. The participation rates of experts in the two rounds of consultation exceeded 90.00%, with an expert authority coefficient of 0.96. The final evaluation system comprised 2 primary indicators, 8 secondary indicators, and 52 tertiary indicators. The primary indicators included project implementation status and project outcomes, with relative weights of 44.44% and 55.56% respectively. Project implementation status included 4 secondary indicators: project organisation, resource allocation, project progress, and safeguard mechanisms. Project outcomes encompassed 4 secondary indicators: healthcare service capacity, regional talent development outreach, and collaborative innovation.Conclusions:The evaluation system established in this study demonstrated a high degree of scientificity and feasibility. It could effectively supported the process management and outcome evaluation of establishing the national children′s regional medical centre. This system provided a scientific basis for enhancing the quality and efficiency of children′s healthcare services, optimising policy formulation and resource allocation.

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.

Economic contract management is the basic work for the healthy and sustainable development of hospitals. At present, the contract management of some public hospitals in China is still in the stage of contract review text, which cannot meet the needs of high-quality development of public hospitals. Drawing on the practice of full lifecycle management of enterprise contract, the author put forward the concept of hospital contract full lifecycle management based on economic and business matters, and systematically introduced the hospital contract management framework and contract management information function design corresponding to this concept. Based on this concept, the hospital carried out the construction and application of the contract management platform, which significantly improved the standardization, refinement and information level of the economic contract management, and had the reference and promotion significance for improving the contract management level of public hospitals.

Economic contract management is the basic work for the healthy and sustainable development of hospitals. At present, the contract management of some public hospitals in China is still in the stage of contract review text, which cannot meet the needs of high-quality development of public hospitals. Drawing on the practice of full lifecycle management of enterprise contract, the author put forward the concept of hospital contract full lifecycle management based on economic and business matters, and systematically introduced the hospital contract management framework and contract management information function design corresponding to this concept. Based on this concept, the hospital carried out the construction and application of the contract management platform, which significantly improved the standardization, refinement and information level of the economic contract management, and had the reference and promotion significance for improving the contract management level of public hospitals.

Under the leadership and high-level promotion of the central and local governments, the construction of national regional medical centers(NRMCs) in China has achieved initial results, and has received recognition and high attention from all sectors of society. The current focus of NRMCs construction has progressed from the project selection to the evaluation of construction effectiveness and the establishment of corresponding operating mechanisms. On the basis of analyzing the characteristics of NRMCs construction and reviewing the evaluation of NRMCs construction at the national level, this paper systematically introduced the monitoring index system and its application of NRMCs construction in Beijing Children′s Hospital, and put forward corresponding policy suggestions. The monitoring of the construction indexes of NRMCs could provide a basis and support for hospitals to identify problems in time, seek government support, and carry out target management, and has reference for promoting the effective construction of NRMCs.

Objectives:To explore the association of interleukin-19 gene polymorphisms with susceptibility and clinical phenotypes of Crohn′s disease (CD) . Methods:A retrospective case-control study was conducted. Eighty-three CD patients and 120 healthy people in Jinhua Municipal Central Hospital with matched gender and age as controls were enrolled. Allele and genotype frequencies of interleukin-19 gene rs2243188 and rs2243193 loci were detected by Sanger sequencing. The differences in allele and genotype frequencies of rs2243188 and rs2243193 loci between the two groups were compared, and the association between gene polymorphisms of the above loci and disease phenotype (disease site and disease behavior) and drug efficacy was analyzed. Results:The allelic and genotypic frequencies of the rs2243188 and rs2243193 loci differed between the two groups (all P<0.05) . Compared with control group, genotype CC+CA of rs2243188 frequency was higher in patients with ileocolonic CD (86.67% vs. 60.00%, OR = 4.333, 95% CI: 1.891-9.929, P = 0.001) , allele C of rs2243188 frequencies were higher in patients with terminal ileal CD (44.44% vs. 37.08%, OR = 5.589, 95% CI: 5.378-5.918, P = 0.019) and ileocolonic CD (50.00% vs. 37.08%, OR = 6.589, 95% CI: 6.378-7.918, P = 0.018) . However, genotype GA+AA of rs2243193 frequencies were lower in patients with terminal ileal CD (55.56% vs. 93.33%, OR = 0.089, 95% CI: 0.020-0.399, P = 0.002) and ileocolonic CD (75.00% vs. 93.33%, OR = 0.214, 95% CI: 0.085-0.540, P = 0.001) , allele A of rs2243193 frequencies were lower in patients with terminal ileal CD (50.00% vs. 70.83%, OR = 0.809, 95% CI: 0.724-0.908, P = 0.023) and ileocolonic CD (47.50% vs. 70.83%, OR = 0.132, 95% CI: 0.008-0.502, P = 0.018) . Furthermore, compared with control group, allele C (49.28% vs. 37.08%, OR = 1.607, 95% CI: 1.397-2.927, P = 0.021) and genotype CC+CA (84.06% vs. 60.00%, OR = 3.515, 95% CI: 1.676-7.374, P = 0.001) of rs2243188 frequencies were higher in patients with ileal lesion, allele A (47.83% vs. 70.83%, OR = 0.742, 95% CI: 0.709-1.741, P = 0.015) and genotype GA+AA (72.46% vs. 93.33%, OR = 0.188, 95% CI: 0.077-0.458, P = 0.002) of rs2243193 frequencies were lower in patients with ileal lesion.Compared with control group, allele A (50.00% vs. 70.83%, OR = 0.243, 95% CI: 0.352-0.679, P = 0.014) and genotype GA+AA (66.67% vs. 93.33%, OR = 0.143, 95% CI: 0.030-0.680, P = 0.006) of rs2243193 frequencies were lower in patients with penetrating CD. Moreover, the rs2243188 polymorphisms were not associated with disease behavior (all P>0.05) , the rs2243188 and rs2243193 polymorphisms were not associated with the efficacy of corticosteroid and infliximab (all P>0.05) . Conclusions:The gene mutation of the interleukin-19 gene rs2243188 locus may contribute to an increased risk for the CD with ileal lesions. But the gene mutation of rs2243193 locus may contribute to an decreased risk for CD with ileal lesions and penetrating CD.

Objectives:To explore the association of interleukin-19 gene polymorphisms with susceptibility and clinical phenotypes of Crohn′s disease (CD) . Methods:A retrospective case-control study was conducted. Eighty-three CD patients and 120 healthy people in Jinhua Municipal Central Hospital with matched gender and age as controls were enrolled. Allele and genotype frequencies of interleukin-19 gene rs2243188 and rs2243193 loci were detected by Sanger sequencing. The differences in allele and genotype frequencies of rs2243188 and rs2243193 loci between the two groups were compared, and the association between gene polymorphisms of the above loci and disease phenotype (disease site and disease behavior) and drug efficacy was analyzed. Results:The allelic and genotypic frequencies of the rs2243188 and rs2243193 loci differed between the two groups (all P<0.05) . Compared with control group, genotype CC+CA of rs2243188 frequency was higher in patients with ileocolonic CD (86.67% vs. 60.00%, OR = 4.333, 95% CI: 1.891-9.929, P = 0.001) , allele C of rs2243188 frequencies were higher in patients with terminal ileal CD (44.44% vs. 37.08%, OR = 5.589, 95% CI: 5.378-5.918, P = 0.019) and ileocolonic CD (50.00% vs. 37.08%, OR = 6.589, 95% CI: 6.378-7.918, P = 0.018) . However, genotype GA+AA of rs2243193 frequencies were lower in patients with terminal ileal CD (55.56% vs. 93.33%, OR = 0.089, 95% CI: 0.020-0.399, P = 0.002) and ileocolonic CD (75.00% vs. 93.33%, OR = 0.214, 95% CI: 0.085-0.540, P = 0.001) , allele A of rs2243193 frequencies were lower in patients with terminal ileal CD (50.00% vs. 70.83%, OR = 0.809, 95% CI: 0.724-0.908, P = 0.023) and ileocolonic CD (47.50% vs. 70.83%, OR = 0.132, 95% CI: 0.008-0.502, P = 0.018) . Furthermore, compared with control group, allele C (49.28% vs. 37.08%, OR = 1.607, 95% CI: 1.397-2.927, P = 0.021) and genotype CC+CA (84.06% vs. 60.00%, OR = 3.515, 95% CI: 1.676-7.374, P = 0.001) of rs2243188 frequencies were higher in patients with ileal lesion, allele A (47.83% vs. 70.83%, OR = 0.742, 95% CI: 0.709-1.741, P = 0.015) and genotype GA+AA (72.46% vs. 93.33%, OR = 0.188, 95% CI: 0.077-0.458, P = 0.002) of rs2243193 frequencies were lower in patients with ileal lesion.Compared with control group, allele A (50.00% vs. 70.83%, OR = 0.243, 95% CI: 0.352-0.679, P = 0.014) and genotype GA+AA (66.67% vs. 93.33%, OR = 0.143, 95% CI: 0.030-0.680, P = 0.006) of rs2243193 frequencies were lower in patients with penetrating CD. Moreover, the rs2243188 polymorphisms were not associated with disease behavior (all P>0.05) , the rs2243188 and rs2243193 polymorphisms were not associated with the efficacy of corticosteroid and infliximab (all P>0.05) . Conclusions:The gene mutation of the interleukin-19 gene rs2243188 locus may contribute to an increased risk for the CD with ileal lesions. But the gene mutation of rs2243193 locus may contribute to an decreased risk for CD with ileal lesions and penetrating CD.