OBJECTIVE To evaluate the cost-utility of iguratimod combined with methotrexate in the treatment of patients with active rheumatoid arthritis （RA） who failed monotherapy with conventional synthetic disease-modifying antirheumatic drugs （csDMARDs）.METHODS A cost-utility analysis was performed. A Markov model was constructed from the perspective of China’s healthcare system with a cycle length of 6 months to simulate the costs and health outcomes [quality-adjusted life years （QALYs）] of iguratimod combined with methotrexate versus different combined csDMARDs regimens over a 30-year time horizon. Efficacy and safety data were synthesized from randomized controlled trials via network meta-analysis. Cost parameters were derived from the Menet Database， published literature and other sources. The discount rate was set at 4.5%， and the willingness-to-pay （WTP） threshold was twice China’s per capita gross domestic product in 2025 （199 330.00 yuan/QALY）. One-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to verify the robustness of the results.RESULTS Compared with methotrexate+sulfasalazine and sulfasalazine+leflunomide， iguratimod+methotrexate was a dominant regimen. Compared with methotrexate+leflunomide， the incremental cost-effectiveness ratio of iguratimod+methotrexate was 60 577.10 yuan/QALY， which was lower than the WTP threshold. Sensitivity analyses and scenario analysis confirmed favorable robustness of the above findings.CONCLUSIONS From the perspective of China’s healthcare system， iguratimod+methotrexate is cost-effective for active RA patients failing csDMARD monotherapy， in comparison with methotrexate+leflunomide， methotrexate+sulfasalazine and sulfasalazine+leflunomide regimens.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Gastric cancer is one of the major types of cancer threatening human health worldwide. Its pathogenesis has not been fully elucidated, and patients are often diagnosed at an advanced stage. The oral cavity is the second largest microbial pool after the intestine in the human body, and thus the relationship between oral bacteria and human health is attracting increasing interest. Oral bacteria are closely related to gastric cancer and potentially serve as noninvasive diagnostic screening biomarkers for the disease. Imbalance in and displacement of these bacteria can promote the occurrence and development of gastric cancer. Hence, this article reviews the association between oral bacteria and gastric cancer, aiming to provide a basis for further elucidating the pathogenesis of gastric cancer and screening it early through noninvasive methods and serve as a reference for subsequent related research.

Objective:To analyze the resilience level and influencing factors of tertiary public general hospitals in Hunan province under the background of major emergencies, so as to provide reference for the construction of resilient hospital and improvement of emergency response ability.Methods:Fifty tertiary public general hospitals in Hunan province that participated in the performance evaluation of national tertiary public hospitals were selected as research samples. The data was sourced from the performance evaluation management platform of public hospitals from 2019 to 2021. The DEA-Malmquist model was used to analyze the static and dynamic efficiency, hospital resilience index model was constructed based on the efficiency indicators, the entropy weight TOPSIS method was used for comprehensive evaluation, and the influencing factors of hospital resilience were analyzed by one-way ANOVA and logistic stepwise regression method.Results:From 2019 to 2021, the average technical efficiency values of tertiary public general hospitals in Hunan province were 0.861, 0.749 and 0.810. The total factor productivity in 2020 decreased by 12.3% compared with that in 2019, the total factor productivity in 2021 increased by 8.3% compared with 2020, and the total factor productivity in 2021 decreased by 5.7% compared with that in 2019. In the context of major emergencies, the hospital resilience index of tertiary public general hospitals in Hunan province was 0.557, and the hospital resilience index of super-scale hospitals and hospitals under the National Health Commission was relatively high, with indexes of 0.647 and 0.715, respectively. The logistic stepwise regression model included three indicators: the number of medical staff with senior professional titles, the proportion of minimally invasive surgery and the average length of stay, and the OR values were 1.005, 1.261 and 0.406, respectively. Conclusions:The efficiency of tertiary public general hospitals in Hunan province needs to be improved, and the resilience level of hospitals under the background of major emergencies is not enough. The hospital resilience index is a useful attempt to evaluate the resilience of hospitals, and can be used as a policy management tool for continuous improvement of health emergency. It is suggested that the tertiary public general hospitals in Hunan province should promote the construction of resilient hospitals from the aspects of emergency talent reserve, research and application of key core technologies, and optimization of operational efficiency management concepts and mechanisms.

Objective:To investigate the predictive value of a clinical imaging model based on multi-slice helical computer tomography (MSCT) examination in predicting prognosis of advanced gastric adenocarcinoma.Methods:The retrospective cohort study was conducted. The clinicopatho-logical data of 88 patients with advanced gastric adenocarcinoma who were admitted to the Ningbo Yinzhou No.2 Hospital from January 2019 to January 2021 were collected. There were 62 males and 26 females, aged (60±15)years. All patients underwent preoperative MSCT examination. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Univariate and multivariate analyses were conducted using the Logistic regression model. The receiver opera-ting characteristic curve was used to analyze the predictive efficacy of prognosis, and the area under the curve (AUC), sensitivity, and specificity were calculated. Results:(1) Surgical situations and follow-up. All 88 patients underwent radical gastrectomy for gastric cancer and were diagnosed with advanced gastric adenocarcinoma through postoperative pathological examination. All 88 patients were followed up after surgery for 41(range, 36?48)months, with a 3-year overall survival rate of 69.32%. (2) Analysis of factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery. Results of multivariate analysis showed that preoperative carcinoembryonic antigen (CEA) and extramural venous invasion (EMVI) were independent factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery ( odds ratio=1.10, 7.72, 95% confidence interval as 1.01?3.82, 1.42?15.42, P<0.05). (3) Construction and evaluation of predictive model. The AUC of predictive efficacy of prognosis for advanced gastric adenocarcinoma of preoperative CEA and EMVI were 0.90 (95% confidence interval as 0.82?0.97) and 0.80 (95% confidence intervalas 0.71?0.89), respectively, with sensitivity of 85.25% and 78.69% and specificity of 100.00% and 81.48%, respec-tively. A predictive model was constructed by combining preoperative CEA and EMVI based on the results of multivariate analysis, and the AUC of the predictive model was 0.93 (95% confidence interval as 0.87?0.98), with sensitivity and specificity of 86.89% and 96.30%. Conclusions:CEA and EMVI are independent factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery. The predictive model constructed by combining preoperative CEA and EMVI has good predictive efficacy for patient prognosis.

Humans ; Bile Reflux/complications* ; Cross-Sectional Studies ; Risk Factors ; Gastric Mucosa

BACKGROUND: With the development of traditional Chinese medicine research, berberine has shown good efficacy and safety in the eradication of Helicobacter pylori (H. pylori). The present study aimed to evaluate the efficacy and safety of triple therapy containing berberine, amoxicillin, and vonoprazan for the initial treatment of H. pylori. METHODS: This study was a single-center, open-label, parallel, randomized controlled clinical trial. Patients with H. pylori infection were randomly (1:1:1) assigned to receive berberine triple therapy (berberine 500 mg, amoxicillin 1000 mg, vonoprazan 20 mg, A group), vonoprazan quadruple therapy (vonoprazan 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, B group), or rabeprazole quadruple therapy (rabeprazole 10 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, C group). The drugs were taken twice daily for 14 days. The main outcome was the H. pylori eradication rate. The secondary outcomes were symptom improvement rate, patient compliance, and incidence of adverse events. Furthermore, factors affecting the eradication rate of H. pylori were further analyzed. RESULTS: A total of 300 H. pylori-infected patients were included in this study, and 263 patients completed the study. An intention-to-treat (ITT) analysis showed that the eradication rates of H. pylori in berberine triple therapy, vonoprazan quadruple therapy, and rabeprazole quadruple therapy were 70.0% (70/100), 77.0% (77/100), and 69.0% (69/100), respectively. The per-protocol (PP) analysis showed that the eradication rates of H. pylori in these three groups were 81.4% (70/86), 86.5% (77/89), and 78.4% (69/88), respectively. Both ITT analysis and PP analysis showed that the H. pylori eradication rate did not significantly differ among the three groups (P >0.05). In addition, the symptom improvement rate, overall adverse reaction rate, and patient compliance were similar among the three groups (P >0.05). CONCLUSIONS The efficacy of berberine triple therapy for H. pylori initial treatment was comparable to that of vonoprazan quadruple therapy and rabeprazole quadruple therapy, and it was well tolerated. It could be used as one choice of H. pylori initial treatment.
Humans ; Amoxicillin/therapeutic use* ; Helicobacter pylori ; Anti-Bacterial Agents ; Clarithromycin/therapeutic use* ; Rabeprazole/therapeutic use* ; Berberine/therapeutic use* ; Bismuth ; Helicobacter Infections/drug therapy* ; Drug Therapy, Combination ; Treatment Outcome ; Proton Pump Inhibitors/therapeutic use*

Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

Bile reflux (BR) can promote the development of chronic gastritis, gastric intestinal metaplasia, gastroesophageal reflux disease, gastric cancer and esophageal cancer. Secondary bile reflux (SBR) develops after pylorectomy or pylorus changed by gastrectomy or subtotal gastrectomy. Primary bile reflux (PBR) develops without surgery of stomach and is a very common phenomenon. This article reviewed the progress of research on risk factors associated with PBR.