Objective To evaluate the efficacy and safety of brexpiprazole in treating acute schizophrenia.Methods Patients with schizophrenia were randomly divided into treatment group and control group.The treatment group was given brexpiprozole 2-4 mg·d-1 orally and the control group was given aripiprazole 10-20 mg·d-1orally,both were treated for 6 weeks.Clinical efficacy of the two groups,the response rate at endpoint,the changes from baseline to endpoint of Positive and Negative Syndrome Scale(PANSS),Clinical Global Impression-Improvement(CGI-S),Personal and Social Performance scale(PSP),PANSS Positive syndrome subscale,PANSS negative syndrome subscale were compared.The incidence of treatment-related adverse events in two groups were compared.Results There were 184 patients in treatment group and 186 patients in control group.After treatment,the response rates of treatment group and control group were 79.50％(140 cases/184 cases)and 82.40％(150 cases/186 cases),the scores of CGI-I of treatment group and control group were(2.00±1.20)and(1.90±1.01),with no significant difference(all P＞0.05).From baseline to Week 6,the mean change of PANSS total score wese(-30.70±16.96)points in treatment group and(-32.20±17.00)points in control group,with no significant difference(P＞0.05).The changes of CGI-S scores in treatment group and control group were(-2.00±1.27)and(-1.90±1.22)points,PSP scores were(18.80±14.77)and(19.20±14.55)points,PANSS positive syndrome scores were(-10.30±5.93)and(-10.80±5.81)points,PANSS negative syndrome scores were(-6.80±5.98)and(-7.30±5.15)points,with no significant difference(P＞0.05).There was no significant difference in the incidence of treatment-related adverse events between the two group(69.00％vs.64.50％,P＞0.05).Conclusion The non-inferiority of Brexpiprazole to aripiprazole was established,with comparable efficacy and acceptability.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective: To investigate surgical strategies and the corresponding benefits for patients with perihilar cholangiocarcinoma(pCCA). Methods: A total of 81 patients with pCCA who underwent radical excision in the Department of Biliary and Pancreatic Surgery of Sun Yat-Sen Memorial Hospital between January 2014 and December 2021 were retrospectively collected.The cohort consisted of 50 male and 31 female patients,with an age of (62.5±11.5)years(range:26 to 83 years).Seventy-five cases were diagnosed with jaundice,60 of whom received preoperative biliary drainage,while 20 patients received portal vein embolization.Their serum bilirubin level within one week before the operation(M(IQR)) was 44.3 (41.9) μmol/L(range:8.0 to 344.2 μmol/L).Preoperative imaging examinations were performed to evaluate the Bismuth-Corlette type of pCCA,showing 3,6,21,27,and 24 cases of Bismuth-Corlette type Ⅰ,Ⅱ,Ⅲa,Ⅲb,and Ⅳ,respectively.The primary outcome was overall survival (OS),and the secondary outcomes were relapse-free survival (RFS),90-day postoperative morbidity and 90-day postoperative mortality.OS and RFS were estimated using the Kaplan-Meier method and compared by the Log-rank test.Significant prognostic factors were determined using univariate and multivariable Cox proportional hazard regression analyses. Results: In the cohort of 81 pCCA patients,67 cases(82.7%) underwent major hepatectomy while 3 cases received major hepatectomy combined with pancreaticoduodenectomy.Thirty-four patients underwent hepatectomy combined with vascular resection and reconstruction(18 cases of portal vein resection and reconstruction alone;9 cases of hepatic artery resection and reconstruction alone;7 cases of combination of portal vein and hepatic artery resection and reconstruction).Margin negative(R0 excision) were achieved in 53.1%(43/81) of these patients.The operation duration was (627±136)minutes(range:565 to 940 minutes),and the intraoperative blood loss was 400(455)ml(range:200 to 2 800 ml).The 90-day postoperative mortality was 3.7%(3/81).Grade 3-4 postoperative morbidity was 23.4% (19/81) according to the Clavien-Dindo classification of surgical complications.Up to the last follow-up at September 2022,the follow-up time was 34.0(24.2)months (range:0.4 to 103.6 months).Three patients who died within 90 days after surgery were excluded from the survival analysis.The median OS was 36.10 months (95%CI:18.23 to 42.97 months) and the 1-,3-and 5-year OS rates were 85.3%,46.8% and 27.3%,respectively.The median OS of 41 patients with negative margins was 47.83 months(95%CI:36.90 to 58.80 months) and that of 37 patients with positive margins was 20.47 months(95%CI:10.52 to 30.58 months).The median RFS of 70 patients with R0 and R1 resection was 24.50 months(95%CI:12.15 to 31.85 months)and the 1-,3-and 5-year RFS rates were 65.2%,45.7% and 29.9%,respectively.The median RFS of 41 patients with R0 resection was 38.57 months(95%CI:21.50 to 55.63 months) and that of 29 patients with R1 resection was 10.83 months(95%CI:2.82 to 19.86 months). Conclusions: The primary therapy for pCCA is radical surgical resection.A precise preoperative evaluation and sufficient preparation can reduce postoperative morbidity.Surgical treatment can achieve a better survival outcome by increasing the radical resection rate.